HOSPITAL POLICY AND PROCEDURES MANUAL
2010 - 2011
1
Table of Contents
Welcome and Mission Statement .................................................................................6
Hospital Code of Ethics......................................................................................................6-7
I: General Information ...........................................................................................................8
Alcohol Policy ....................................................................................................................... 8
Boarding Policy ..................................................................................................................... 8
Children at the VTH ..............................................................................................................8
Cleaning
........................................................................................................................8
Dress Code
8
ID Badge/Building Access.....................................................................................................9
Keys
....................................................................................................................... 9
Mailboxes
....................................................................................................................... 9
Notary Services ...................................................................................................................... 9
Notices, Flyer, Announcements ............................................................................................. 9
Parking and parking Permits ..................................................................................................9
1. Clinician, Resident, Intern, State Classified and Employee ............................... 9
2. Students...............................................................................................................10
3. Long-term Visitor ............................................................................................... 10
4. Visitor Pay-N-Park ............................................................................................. 10
5. Bicycles and Motorcycles ................................................................................... 10
Photocopying 10
1. Clinical Sciences .................................................................................................10
2. Director‟s Office .................................................................................................10
3. Medical Records .................................................................................................10
Photography Laboratory (CATS) .......................................................................................... 10
Sharps
....................................................................................................................... 10
Telephone/Pager .................................................................................................................... 11-12
Long Distance Access Code ..................................................................................................13
II: Hospital Administrative Information .........................................................................14
A.
B.
C.
D.
Accidents or Injuries ......................................................................................................14
Animal Bites................................................................................................................... 14
Building Safety Plan ......................................................................................................15
Care Credit ..................................................................................................................... 15
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E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
Companion Care .............................................................................................................15-16
Confidentiality ................................................................................................................16
Discount Policy ..............................................................................................................16
Health Insurance ............................................................................................................16
In-Depth Cleaning Procedures Using Virkon.................................................................
Personal Pets .................................................................................................................. 16
Personnel ....................................................................................................................... 16-17
Referrals from VTH to Other Facilities .........................................................................17
Refuse Treatment ...........................................................................................................17-18
Shipping Animals............................................................................................................18
Storage Space .................................................................................................................. 19
Stray Animals ................................................................................................................. 19
Suspected Cruelty ..........................................................................................................19-20
III: Hospital Admission/Dismissing ...................................................................................21
A. Abandonment ................................................................................................................. 21
B. Admissions/General .......................................................................................................21
C. Admissions After Hours .................................................................................................21-22
3a. New Patients .....................................................................................................22
3b. Small Animal Adoption Policy .........................................................................23
D. Admissions Examination Procedure ..............................................................................23
E. Admission Unidentified, Sick and injured Animals Presented by ................................ 23
1. Acceptable Cases for Treatment .........................................................................24
2. Larimer Humane Society Emergency contact Information ................................ 24
3. Animals with an Owner that cannot be reached ................................................. 24-25
4. Financial Limitations for Initial Treatment ........................................................ 25
5. Follow-up With the Larimer Humane Society ................................................... 25
6. Raptors ................................................................................................................25
7. Wildlife ...............................................................................................................25
F. Animals Dropped Off the Night Before .........................................................................25
G. Dismissing Large and Small Animal Patients ............................................................... 26
H. Dismissing Patients After – Hours................................................................................. 26
I.
Disposal of Animals ......................................................................................................27
J. Donation (Patient/Non-patient Animal .........................................................................27
1. Large Animal Donations..................................................................................... 27-28
2. Small Animal Donations..................................................................................... 28
K. Euthanasia-Postmortem-Cremation ...............................................................................28
1. Animals that are in the Hospital .........................................................................28-29
2. Re-entry of Previous Patients for Donation for Euthanasia ................................ 29
3. Disposition of Animals Within VTH ..................................................................29
a. Client Animals ........................................................................................ 29
b. CSU_VTH Animals ................................................................................29
c. Research Animals ................................................................................... 29
L. Hospitalization................................................................................................................29
1. Large Animal ......................................................................................................29-30
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2. Small Animal ......................................................................................................30
M. Re-Admissions ...............................................................................................................30-31
N. Referral Clients/Patients ................................................................................................ 31
1. Appointments – Scheduling ................................................................................31
2. Role of Receptionist............................................................................................ 31
3. Role of Clinicians ............................................................................................... 31
4. Role of Medical Records .................................................................................... 32
5. Minors, Animals Submitted By ..........................................................................32
6. Personal Animals – Students or Employees ....................................................... 32
7. Referrals to Other Practices ................................................................................32
IV: Clinical Assignments .......................................................................................................33
A.
B.
C.
D.
E.
F.
G.
H.
I.
After-Hours & Weekend Duty Including “on call” ....................................................... 33
Clinical Assignments .....................................................................................................33-34
Clinic Rotation Rounds Rooms ...................................................................................... 34
Clinical Projects .............................................................................................................35
Emergency phone call duty ............................................................................................ 35
Grading ....................................................................................................................... 35
Interns & Residents – Large Animal/Small Animal ...................................................... 35-36
Items to Carry With You................................................................................................ 36
Practicing Veterinary Medicine ...................................................................................... 36
V: Hospital Services / Patient Services .............................................................................37
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
Anesthesia ...................................................................................................................... 37-41
Cardiology ...................................................................................................................... 41-42
Community Practice .......................................................................................................43-45
Dermatology .................................................................................................................. 45
Equine Ambulatory ........................................................................................................45-46
Equine Services ..............................................................................................................46-47
Food Animal Introduction.............................................................................................. 47-66
Large Animal Emergency Medicine ..............................................................................66-71
Neurology ...................................................................................................................... 71-72
Oncology ....................................................................................................................... 72-79
Ophthalmology ..............................................................................................................79-80
Preventative Health Program (PHP)..............................................................................80-81
Small Animal Medicine Services ................................................................................... 81-89
Small Animal Surgery Services (and related) ................................................................ 89-101
VI: Support Services ................................................................................................................102
A.
B.
C.
D.
E.
Animal Behavior Counseling ......................................................................................... 102
Argus
....................................................................................................................... 102-103
Central Supply Procedure .............................................................................................. 103-105
Clinical Pathology..........................................................................................................105-110
Computer Procedures .....................................................................................................110-113
1. VetPoint .............................................................................................................113-119
F. Diagnostic Imaging Procedures ...................................................................................... 119-130
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G. Diagnostic Laboratory Procedures ................................................................................. 131-165
H. Medical Record Department .......................................................................................... 165-167
I. Pharmacy Procedures ......................................................................................................167-171
VII: Appendix Forms ...............................................................................................................172
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Welcome to the Veterinary Teaching Hospital
Information provided in this manual will answer most questions and guide students, staff and faculty in
carrying out their duties in the VTH. Please do not hesitate to ask questions concerning items that are not
understood.
Staff and faculty are here to help students learn medical and people skills. Staff members are is responsible
for running their sections in a smooth and efficient manner. Students learn a great deal from these people and
should not hesitate to ask for guidance.
Hospital Code of Ethics
Preamble
Our institution is a specialized center devoted to the care of animals with disease and the prevention and
eradication of disease. We strive to combine the activities of patient care, prevention, education, and research
to benefit not only patients and their owners currently receiving care, but also future generations. We hold
before us this Code of basic moral principles to guide our service and bond patients and staff together in the
difficult task of contending with illness.
Principle 1
Reverence for the animals and their owners for whom we are privileged to care is our primary concern. Such
respect affirms the value and dignity of life.
Principle 2
Curing disease, reducing suffering, and achieving an acceptable quality of life, as defined by the client with
the help of healthcare professionals, are the central goals of our institution. The presence of disease may
justify, but not demand, heroic measures. We recognize that the ability to provide humane euthanasia in the
absence of reasonable alternatives is a privilege not to be taken lightly.
Principle 3
The diagnosis of disease may carry with it serious emotional and financial burdens for clients, including the
burden of making and living with difficult choices. It is our responsibility to offer support and assistance by
providing our clients with the information they need to make decisions.
Principle 4
Medical information is confidential and may not be disclosed to third parties without client consent. All
information must be recorded accurately and communicated responsibly. Access confers an obligation to
protect patient privacy and personal
interests.
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Principle 5
Prevention of disease is an essential part of our mission. Through public education, clinical preventive
service, and research, we strive to reduce the incidence of disease and serve animals who may never be our
patients.
Principle 6
Education is both an investment in a better future and a tribute to past generations of patients, clients, and
scholars. Our educational mission embraces those who come to us to learn -- our clients, the public, and our
colleagues. We commit ourselves to further progress against disease by sharing the knowledge, skills, and
ethical values that are the foundation of this institution.
Principle 7
Basic and clinical research are central to our mission. They are fundamental to the prevention, diagnosis,
treatment, and ultimately the eradication of disease. Research requires the performance of a variety of
activities that have been designed to improve patient care and quality of life, and it is essential that owners
who allow their pets to participate in these activities be adequately informed of any known or anticipated risks
and benefits. Such research must reflect the highest standards of research integrity including accurately
collected, precisely analyzed, and honestly reported data.
Principle 8
All who serve in this institution have specific tasks and roles, yet all are equal in their capacity to befriend
patients and clients. Individually, each of us bears a moral obligation to our patients and clients.
Principle 9
We affirm the need to demonstrate mutual respect and acknowledge interdependence as coworkers
responsible for the welfare of patients.
The Faculty, Staff, and Students of Colorado State University‟s Veterinary Teaching Hospital – February
2009
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I: General Information
Alcohol Policy
The consumption of alcohol is prohibited within the Veterinary Teaching Hospital. Failure to adhere to the
policy could result in dismissal or loss of clinic privileges. For more information, please see the CSU policy
on Alcohol and Drugs/Alcohol on Campus
(http://policies.colostate.edu/PolicySearch.aspx?xGplID=TjwR3yh5KBs=) Policy ID: 6-04261989-1.02
Boarding Policy
The boarding policy was developed by the VTH Board and approved by the faculty in the fall of 1979. This
policy has been reviewed and reaffirmed at subsequent VTH Board meetings.
A “No Boarding Policy” was developed and approved in November 1979. Any client (anyone whose pet is
admitted for medical reasons) who must bring an animal into the hospital for medical or post treatment
evaluation reasons is not in violation, provided that a clinician is assigned to the case. Cage identification
must be present on all animals and the animal must appear on the hospital census. These clients will be
charged regular hospitalization. NO animal should be kept in the hospital for general boarding purposes
unless unusual circumstances exist and the Hospital Director has approved the particular case.
Faculty, house officers, staff and students must have approval from the hospital director prior to bringing
their pet into the hospital unless the pet has an appointment. If the pet is approved for a day visit the
Outpatient Day Fee will be charged and no discount will be applied. Appendix: Outpatient_Day_Fee
Children at the VTH
Children are not permitted in the hospital when the parent is on duty. Please refer to the policy memorandum
regarding presence of children in the VTH. Appendix: Children_at_the_VTH
Cleaning
„Clean as you go‟ applies to everyone. No one is responsible for cleaning up after someone else. However, if
you observe trash or animal waste left behind by an unknown individual, please take the time to clean it up as
a matter of biosecurity and courtesy.
Dress Code
In summary, daily attire should be neat, clean and professional and reflect the section of the hospital to which
you are assigned. Smocks, scrub suits or coveralls and boots are used as outer garments depending on
assignment. Footwear must be protective, clean and cleanable. The clinician on clinical duty has the
authority to mandate which apparel may or may not be appropriate for his/her clinical service. Please refer to
the VTH/DL Dress Code Policy document for details regarding appropriate attire for different services of the
VTH. Appendix: VTH_Dress_Code
8
ID Badge/Building Access
All hospital faculty, residents, interns, staff, students, volunteers and visitors are required to wear an
identification badge when in the Veterinary Teaching Hospital. The badges must be visible and worn at all
times when on hospital grounds. The Director‟s Office issues the badges. Lost badges must be reported at
once and a $10.00 (nonrefundable) fee will be assessed for a replacement. Your photo ID badge (or visitor
badge) must be turned in to the Director‟s Office if you are no longer working or enrolled at the university.
Transactions/services at service centers (Pharmacy, Central Supply, Radiology, Clinical Pathology, and
Medical Records) will not be allowed unless the person ordering has photo identification in plain view. All
persons not wearing VTH identification badges will be referred to the Director‟s OfficeIf you have been
approved to have a proximity card, there are several locations that will allow you access day or night. The
only way you can enter the hospital at times will be through a door with a proximity reader using your
individual proximity card. Please do not allow others to use your proximity card! The „proxy‟ entrances have
been installed for security purposes. Security cameras are also in operation for personnel safety.
Keys
Keys are ordered by the Director‟s Office from facilities on campus. You will need to fill out a key order
form from the Director‟s Office and have it signed by your supervisor. Return the form and the order will be
placed. Keys take up to 2 weeks to come in.
Mailboxes
Mailboxes are supplied for faculty, residents, interns and staff members on the second floor in room A205. A
mail drop is provided for outgoing mail in the Director‟s Office.
Notary Services
Notary services are available in the Department of Clinical Sciences, A201, and in the Director‟s Office,
A103. There is a $1.00 charge for items notarized that do not relate to Veterinary Medicine (i.e. wills, titles,
passports, etc.).
Notices, Flyers, Announcements
Bulletin boards are placed throughout the hospital. These boards will contain special announcements, seminar
notices, open positions and classified personnel job openings, etc. All notices posted on these boards should
be dated at the time of posting and will be removed at an appropriate time, ordinarily two weeks to thirty
days. Grip-a-note bulletin bars on doors are to be used for posting hospital related communications after
clearance through the Director‟s Office. No notices of any kind are to be taped, attached or stuck
Parking and Parking Permits
All faculty, staff, hourly employees and students should park in the A and Multi parking areas on the west
side and north east of the hospital. The parking areas south and the trailer parking east of the hospital are for
clients only. All parking is regulated and no overnight parking is allowed anywhere on the Colorado State
University campuses. A copy of current parking regulations as approved by the State Board of Agriculture is
available from University Parking Services, Green Hall.
Failure to follow these parking regulations will result in University Parking Services issuing tickets to the
offenders.
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1. Clinicians, Residents, Interns, State Classified Staff and Employees
An employee "A" permit must be purchased from University Parking Services located in Green Hall and is
valid for the fiscal year July 1 through June 30 the following year. New employees should secure a
memorandum from their home department (Clinical Sciences, Diagnostic Lab or Director's Office) before
attempting to purchase the permit.
2. Students
Students must obtain a student, "Z", parking permit from University Parking Services located in Green Hall.
3. Long-term visitors
Long-term visitors should obtain a memorandum from the department coordinating the visit if wishing to
purchase a temporary parking permit.
4. Visitor Pay-N-Park
Short –term visitors should obtain a daily pass from the dispenser in the north west Multi-Use Lot. The cost
is $6.00 and may be used in the Multi-Use Lots and on the CSU campus during the same day.
5. Bicycles and Motorcycles
Bicycle racks are available at the north east end of the hospital and the east side by the large animal
admissions door. Bicycles are not allowed in the hospital or barns. Bicycles should not be chained to various
objects around the buildings (i.e. benches, trash containers, trees, light poles, etc.) Motorcycle
parking is available in the west parking lot.
Photocopying
1. Clinical Sciences
A photocopy machine is available for faculty, interns and residents in room A203. Each user will be assigned
an access number. Do not share this number with other users. Personal work, copying of reprints, etc. should
be paid for on an individual basis ($.10 per copy). The copy machine in the library is for student use
($.05/copy). Students may not use the copy machine in A203.
2. Director‟s Office
This copier is for the use of the Director‟s Office only. If you have a large job to be copied, please contact the
Director‟s Office for referral to an appropriate service.
3. Medical Records
Faculty, staff and students may use this copier for clinic business only.
Photography Laboratory (CATS)
The Computer Assisted Teaching Support (CATS) lab was created to assist and instruct college faculty, staff,
and students in preparing and presenting teaching material using the latest technology in computer
10
presentation equipment and methods. Our facilities include slide scanners, flatbed scanners, radiograph
scanners, digital video editing and output computers, CD and DVD duplication services, large format poster
printing, digital photography and photomicroscopy, and digital color printing. Our equipment is available for
use by faculty, staff, and students at no cost, and with the guidance and expertise of the CATS staff. There are
costs for certain materials and supplies. Our hours are from 8 AM to 5 PM, Monday through Friday. Our
computer lab is in Room-237. Our office is Room A-220. The CATS Lab also provides maintenance and
upkeep for the visual projections units located in the hospital classrooms.
Sharps
“Sharps” must be disposed of properly. Hypodermic needles are not to be recapped. Place blades, suture or
hypodermic needles and other sharp objects in “sharps containers” that are located throughout the hospital.
..\PM 09_10\Hospital Procedures Manual 09-10\Appendix\Sharps Policy 8 6 10.pdf
Telephone
For incoming calls, the primary switchboard number is (970) 221-4535. The secondary switchboard number
for incoming calls is (970) 491-7101.
Numbers To Dial In Order To Reach (calling from within the VTH)
A T & T Operator:
8 + 00
Campus Operator:
1-1101
Campus or VTH calls:
5 digit extension
Credit Card Calls:
8 + 0 + Area Code + number -- listen for a brief burst of tone followed
by the credit card authorization tone -- dial your credit card number.
Collect:
8 + 0 + Area Code + 7 digit number -- operator will
come on and ask how call is to be billed
EMERGENCY (911)
911
Information:
8 + 1 + Area Code + 555-1212 and your authorization code (local and
other)
Local Off Campus:
8 + number
Long distance
8 + 1 + (10 digits) + authorization code
8 + 011 + (number) + authorization code
(national):
(international):
US West Operator:
8+0
VTH Extensions:
7-4100 to 7-4199
7-1200 to 7-1299
7-0300 to 7-0399
7-4400 to 7-4499
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7-4500 to 7-4599
7-7600 to 7-7699 (VTH use only)
VTH Operator:
0
VTH Pager:
7-1200, tone, then 3 digit pager #
Telephone repairs: Telephone problems should be reported to John Gerwig via email,
John.Gerwig@colostate.edu or call John at 297-7444.
The switchboard has an operator on duty from 8:00 a.m. to 5:00 p.m., Monday through Friday. From 5:00
p.m. to 10:00 p.m. on these days all calls from the switchboard (221-4535) are forwarded to extension 4477 in
the Small Animal Office. All other numbers, 297-4471, 297-4472, 297-4477 and 491-7101 are forwarded to a
recording (ext. 214) indicating hospital hours and to call 221-4535. For emergency service after 10:00
p.m. the student on duty will call forward ext. 4477 to ext. 1241 where calls will be answered by the
receptionist on duty in the Intensive Care Unit. Saturday and Sunday the calls are answered during the day at
the small animal desk and at night, again in CCU.
How to Use The Beeper System:
Dial 297-1200, Tone (From Within the VTH)
Dial 297-1200 (If You Are Off Campus)

Wait For The Tone

Put In The 3 Digit Pager Number

Wait For The Tone

Leave Your Message - You Have 10 Seconds
Student Beeper Units For After Duty Hours:
SAS Group A
800
SAS Group B
801
SA Anesthesia
802
Equine Ambulatory
personal pager* or 803
FA Ambulatory
personal pager* or 804
LA Anesthesia
personal pager* or 802 or 805
Equine Surgery
807
* Personal pagers should be tried first
Telephone Directions to The Hospital:
Directions from outside the VTH
Directions from within the VTH
297-4488
297-4488
Dictation:
Outside VTH
Internal (within the Hospital)
297-4503
297-4503
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Long Distance Access Code
To make a long distance call you must have a long distance access code. The Director‟s Office will request a
long distance access code from Telecommunications for you. This code is used to track your long distance
calls. Do not share this code.
Dial 8 + 1 + Area Code and number, listen for three beeps, then dial the Authorization Code at the dial tone.
13
II: Hospital Administrative Information
A. Accidents or Injuries
All paid University employees, including student, non-student and work-study hourly employees are covered
by Workers‟ Compensation Insurance in the event of an accident which occurs on the premises of the
hospital, provided the accident was work related. An “Online First Report of Injury” should be filled out and
submitted within 24 hours of the accident. The link to the Environmental Health Services website is located
on VTH south campus home page listed as EHS Workers Comp Injury Reporting or you can go to:
http://www.ehs.colostate.edu/WWorkComp/OnlineInjury.aspx. A list of providers with clinic name, phone
number and location can also be found on this page. The Work-Related Illness and Injury report on the VTH
webpage should also be filled out. You can access this form by going to www.vth.colostate.edu. The
workers‟ compensation department policy regarding emergency treatment for work-related injuries requires
that the individual seek treatment.
In a life- or limb-threatening emergency go directly to the nearest emergency room.
Any bills or statements received by the injured party should be mailed to Environmental Health Services, 141
General Services Building.
Veterinary students who are injured at a Colorado State University facility, (Veterinary Teaching Hospital,
main campus or foothills campus) during training programs and patient care are not covered by Workers‟
Compensation. Those injuries should be treated by the Student Health Center or their personal physician and
paid for through a personal insurance claim or other personal resources. Those students that are on field
service duty or externships are covered by Workers‟ Compensation during the time they are involved in this
type of service.
Volunteers at the Veterinary Teaching Hospital are required to carry personal health insurance.
B. Animal Bites
A VTH Bite Report Form is required, blank forms are available in the Director‟s Office or Small Animal
Reception. The form is to be completed in its entirety, signed and returned to the Director‟s Office. The
completed report will be forwarded to the LHS. The original VTH report is filed in the VTH medical record
of that animal and a copy is filed in the Director‟s Office. If the person bitten (clinician, staff, student or
hourly) requires medical treatment, that person should seek treatment at a hospital or doctor‟s office
emergency service. Students see insurance coverage or non-coverage policies listed under „Accidents‟ page ?.
Staff, hourly and Clinician‟s should also fill out the Workman‟s Comp form online at Environmental Health
Services website, http://www.ehs.colostate.edu/WWork Comp/HealthContPrint.aspx. Under “Workers‟
Compensation and Health Care Providers.”
If medical treatment is not required, a VTH bite report is still required for clinician, staff, student or hourly.
Whether or not the person bitten requires medical attention, the owner of the animal is to be advised of the
incident and informed the Humane Society will contact them regarding the vaccination status of their animal.
Appendix: Animal_Bite_Form
14
C. Building Safety Plan for the James L. Voss Veterinary Teaching Hospital
Fire safety, emergency procedures and building evacuation plans for the Veterinary Teaching Hospital.
http://www.vth.colostate.edu – Safety Plan; Appendix: Client_Management_Recommendations..\PM
09_10\Hospital Procedures Manual 09-10\Appendix\BLDG SAFETY PLAN 2010.doc
D. CareCredit®
CareCredit® is a company (not affiliated with CSU or the state of Colorado) which offers select payment
plans for approved applicants. This is a dedicated line of credit for veterinary needs.
Between the hours of 8:00 a.m. and 10:30 p.m., please refer your client to the Business Office or after-hours
receptionist for assistance with this program.
Between the hours of 10:30 p.m. and 8:00 a.m. you may do one of the following:
1. Take the required emergency fee and deposit in another, accepted form of payment and tell the client
to call the Business Office prior to 9:00 a.m. on the next business day to make CareCredit®
arrangements. Make sure the client understands that if they are not approved for CareCredit® we will
be processing whatever other form of payment they provided.
2. Assist the client with the very easy-to-use web site where you will get a fairly quick response
indicating approval (or not) and the amount approved.
-Make sure you have a copy of the approval notice
-Get a signed CareCredit® slip (this is vital!). The „plan‟ the client is choosing must be indicated
on this form. These slips are located in the drawer under the forms at Small animal Reception
with the after-hours deposit envelopes.
-Place the documents in the after-hours drop box.
The CSU Veterinary Teaching Hospital is offering the following promotional programs through CareCredit®:
Interest Free Plan
Treatment amount of $300.00 or more – 3 months, no interest*
*If balance is paid within 3 months, no interest fees are assessed
*If balance is not paid within 3 months, a variable interest rate will apply (currently 22.98%)
Extended Payment Plan
Treatment amount of $1000.00 or more – 24/36/48/60 months to pay
*Competitive interest rate of 11.9% APR for 24, 36, 48 or 60 months
For online applications, please go to www.carecredit.com
Appendix: CareCredit
E. Companion Care Fund
The Colorado State University Student Chapter of the American Animal Hospital Association (SCAAHA)
established this fund on March 29, 2000. This fund is an endowed fund established with the CSU Foundation.
The purpose of this fund is to provide limited financial assistance to owners of pets in medical need who are
seeking medical treatment at the James L. Voss Veterinary Teaching (VTH) and do not have the financial
15
capability of providing the medical treatment. Fund disbursement shall be based solely on financial need.
There are restrictions. The faculty clinician in charge of the case determines whether or not the client
qualifies for financial assistance from the Companion Care Fund based on the clinician‟s best judgment of the
client‟s financial need, the animal‟s quality of life, and the continued care and management to be provided by
the owner. To qualify, the client must exhaust all possible financial resources, including family and friends,
credit cards, and Care Credit®. Please see the Business Office for details about the fund or for application
processing. Appendix: Companion_Care_Fund_Request_Form
F. Confidentiality
The medical record represents a document that may contain confidential information relating to the client or
the patient‟s medical problem. Ethics of the profession prohibit release or dissemination of this information
beyond the bounds of the VTH unless client permission is received. Similarly, referring veterinarian‟s work is
not to be discussed with clients. Pictures, videos, and any other media pertaining to patient care can only be
used for tracking and continuing education. It is not acceptable to use any image, video or other media on
social or other non-VTH websites.
G. Discount Policy
The VTH provides a discount on all services to PVM students, residents, graduate students and interns.
Please refer to the CSU VTH Student Discount Policy for more details regarding this opportunity.
Appendix: CSU_Discount_Policy
H. Health Insurance
Students are not covered by a health insurance policy through the Veterinary Teaching Hospital. Therefore,
all students are strongly advised to carry their own health insurance, either through a private company, the
AVMA or Hartshorn Student Health Services at Colorado State University.
I. In-Depth Cleaning Procedures Using Virkon
..\PM 11_12\Policies_Procedures\In Depth Cleaning Procedures 052711.pdf
J. Personal Pets at the VTH
Only animals registered as patients are allowed in the hospital except by special permission from the Hospital
Director. Please refer to the Outpatient Day Fee Policy memorandum for more information on the approval
process and cost. Appendix: Outpatient_Day_Fee
K. Personnel
All personnel actions for the VTH are handled by the hospital Director‟s Office. The office will act as a
liaison to clarify University personnel policies and procedures. All vacant and newly created positions will be
filled according to the provisions of the Personnel and Payroll Manual. The office will assist section heads
and supervisors with personnel related matters in the areas of: testing, interviewing, classification, discipline,
sick and annual leave, etc.
State classified employees whose classification is eligible for shift differential are paid premium pay if they
work a shift designated as premium pay eligible. If one-half or more of the hours worked fall between 4:00
p.m. and 11:00 p.m., second shift pay will be applicable. If one-half or more of the hours worked fall between
16
11:00 p.m. and 6:00 a.m., third shift pay will be applicable. For health care services classifications, there is
weekend/holiday shift differential pay.
State classified employees must submit a Request for Leave form before an anticipated period of leave, either
annual vacation or travel leave. Leave is subject to approval by the supervisor. The Request for Leave form
must also be submitted following leave for illness. Annual leave or sick leave cannot be interchanged, with
the exception that annual leave may be used when sick leave has been exhausted. Leave without pay may
only be granted for extended periods of time, and must be submitted in advance to the hospital Director‟s
Office which will submit the request to the University Personnel Director for approval. A month-to-month
record will be kept in the time clock of individual leave earned, used, and remaining.
Applications for hourly and temporary employment are accepted in room A102. The office will coordinate
temporary non-student, student, and work-study employment. A background check must be completed before
being hired. All necessary paperwork MUST be completed with the Personnel/Payroll Office before an
hourly employee can start working. All hourly personnel and state classified personnel are required to use the
time clock to record hours worked. All hours worked in excess of 40 hours per week are considered comp
time/overtime.
Hourly personnel are paid every-other-week as established by University Payroll. State Classified personnel
are paid on a monthly basis and receive their pay on the last working day of each month. State Classified
hourly personnel are paid on the same schedule as hourly non-classified personnel.
All State Classified personnel records will be maintained through the Personnel/Payroll Office, room A102.
All faculty records will be maintained through the Department of Clinical Sciences, room A201.
More information on State Classified, Admin Pros, faculty, and student employment can be found in the
manuals located at: http://www.hrs.colostate.edu.
L. Referrals from VTH to Other Facilities
As a public institution, the VTH cannot provide preferential recommendations to clients for referral to outside
practices for veterinary medical care, or to businesses that provide grooming, boarding, hospital care,
cremation or other allied pet care services. However, it is our duty to provide unbiased information when
requested. Appendix: VTH_Referral_Policy
If an individual who requires general medical or surgical attention for their animal requests referral
information for general veterinary practitioners, please refer them to the local telephone directory yellow
pages. If the VTH cannot accommodate an individual quickly enough, who requires specialty practice
attention for their animal, the names and contact information for local/regional specialty practitioners may be
provided. A list of these specialty practices is maintained and updated regularly by the VTH Front Reception
Desk, based upon those practitioners who have indicated willingness to be referred to when needed.
If a client requests referral information for ancillary pet care services, including but not limited to grooming,
boarding, hospital care, or cremation, the names and contact information for local/regional businesses may be
provided. VTH personnel are urged to remember that such outside businesses may not be subject to
accreditation or inspection standards like those used to certify specialty practitioners or veterinary practices.
As such, VTH personnel cannot certify the quality of care provided by these services at any one time, though
past person experience with individual businesses may be provided if the client request such information.
17
M. Refusing Treatment Procedures
Our clients are often very dedicated, passionate people. They come to us with high expectations and when
stressed and worried they can seem demanding and sometimes, unpleasant. It can be difficult to determine
when is the right time to require that a client seek medical care for their pet elsewhere. Please review the
following standards and the process the VTH uses to determine appropriate action.
Some examples of behavior that requires discussion:
 Threatening actions or words
 Sexual advances
 Unwanted contact from client unrelated to the patient
 Consistently unwilling to pay for service rendered
 Unwilling to follow medical instruction
 Abusive language or behavior that negatively impacts VTH personnel
If you experience any of the above or any other offensive behavior please take the following steps:
 Notify the faculty clinician on the case/service
 Notify the Directors Office and/or the Office Manager
 Document the offending behavior, date and time
 Depending on the nature of problem, it may be helpful to involve the Argus group
Options:
 Faculty clinician, Hospital Director or the Office Manager having a conversation with the client
 Providing the client with a written document outlining the services we are able to provide and our
expectations if we are going to have a productive relationship
 Suggesting that another hospital might be a better fit and acknowledging that our hospital is not for
everyone
 Requiring that the client seek medical care elsewhere
The last option is only used in the most extreme situations and can only be approved by the Hospital Director.
A letter, approved by the Hospital Director, explaining this decision must be provided to the client.
* It is important to note that, while possible, it is unadvisable to discontinue service to a client during a
treatment plan with a patient.
N. Shipping Animals
Shipping Animals to VTH
It is the responsibility of the client to advise the Hospital at least 24 hours in advance of the arrangements for
travel when an animal is being shipped. Animals must be shipped prepaid.
The client will need to make arrangements to have the pet transported from DIA to Fort Collins. The
receptionists can provide you with names and phone numbers of the pet transport services.
18
Shipping Animals to Owners:

The clinician will notify the client that the pet is ready to go home. The client will make transport and
travel arrangements. It is the responsibility of the client to advise the Hospital at least 24 hours in
advance of the arrangement for travel when an animal is being shipped.

The clinician will insure that payment for services rendered has been received prior to releasing the pet
for travel. Proper shipping documents are required including current health certificate, name of client
and address, names of contacts for flights requiring transfers, phone numbers of responsible people,
and any other pertinent information.

Inform the owner that we are not covered by liability insurance for transporting animals and the owner
should provide insurance.

Large animal transportation costs vary according to distance traveled. In the event of transportation of
a very valuable animal (in excess of $25,000), please inform the Director's Office prior to travel, so
arrangements can be made for a "rider" to be added to insurance policy for the specific case. (All
large animal transportation should be arranged through „The Shop‟ at extension 7-0340).
O. Storage Space
Storage space in the hospital is limited therefore

Leave coat, purse & knapsack in your locker. SECURE THE LOCKER!

Reference books & notebooks can be left in rounds rooms when in clinics.

It is common for students and staff to leave laptop computers and personal digital assistants in rounds
rooms when in clinics. Please assist your colleagues by keeping an eye on valuables that they may
leave unattended, and be aware that these items are not secure if left in the rounds rooms.
P. Stray Animals
Healthy stray animals are not accepted at the Veterinary Teaching Hospital. These are referred to the Larimer
Humane Society at 970-226-3647.
Q. Suspected Cruelty – Hospital Policy
At the September 10, 1987 VTH Board Meeting a policy statement was established and approved for the
handling of suspected animal cruelty cases presented to the Hospital.
As of July 1, 2007 Colorado Veterinary Practice act was revised; Title 12 Article 64-101, this act requires
veterinarians to report any suspected abuse.
"The CSU College of Veterinary Medicine and Biomedical Sciences have a long-standing
commitment to the welfare of all animals. By the same token, society in general has long proscribed
certain behavior towards animals through the anti-cruelty statutes of the criminal law. The VTH
therefore acknowledges an obligation to report to the proper authorities when there are reasonable
grounds to suspect that cruelty may have occurred. All such cases will be reported in writing to the
Hospital Director for his disposition".
If the Hospital Director is not available, the Section Head involved will review the situation and if appropriate
report findings to the Director of the Larimer Humane Society.
19
Hopefully this statement will help direct true suspected cases of animal cruelty (i.e. starvation, willful neglect,
inflicted trauma) toward a meaningful solution through the Larimer Humane Society and local authorities.
20
III: Hospital Admission/Discharge
A. Abandonment of Animals
All Abandonment Procedures Must Be Initiated Through The Business Office
Any owner or agent (excluding donations or unknown owners) presenting an animal(s) to the VTH for
diagnosis, examination, treatment, rehabilitation, etc. will be financially and legally responsible for that
animal(s). If the owner or agent cannot be contacted (in person, by phone, or by letter) within 5 working days
of the initial contact, or the owner makes no effort to pick up their animal(s), abandonment procedures may
be initiated by contacting the hospital director.
A certified letter will be sent by the business office manager to the last known address of the owner/agent
containing the statement: "pursuant to Colo. Rev. Stat. 12-64-115, you are advised that the animal described
above is considered to be abandoned property." This statement is also paraphrased on the admission sheet
which the owner/agent signs for authorization of treatment. Ten days will be allowed from the date of receipt
of the letter by the client to the disposal of the animal(s). We can dispose of the animal by:
a. selling it (large animals if in marketable condition)
b. using in teaching program
c. euthanasia
d. release to the Humane Society.
If the owner/agent can be contacted but does not want to pay the bill (or deposit) and continues to leave the
animal in the hospital the following should be considered:
Asking the owner/agent to pay a portion of the fee
Asking owner/agent to contact the Larimer County Humane Society to arrange for the surrender of the animal
to them.
Start abandonment procedure as stated above and turn account over for collection.
To be able to collect accounts on owner/agent animals we must have a signed treatment authorization form
and fee estimate sheet. In the case of most large animals, the outstanding balance will be reduced by the sale
price animal. The balance will then be sent to the collection agency.
B. Admissions General Information
All animals to be treated at the Veterinary Teaching Hospital must have a case number; record created and
assigned to a clinician.
C. Admitting After-Hours
These instructions are intended to supplement your knowledge of the Hospital requirements for admitting
patients. PRIOR to taking evening or weekend duty, stop by the Reception Desk to familiarize yourself with
the card embosser, the forms, and their location. The office staff welcomes questions. A complete business
procedures manual is available in both the large and small animal reception offices.
21
Any clients entering the VTH on an emergency basis will be charged the emergency fee. Place the payment
and a copy of the interim receipt in an envelope and put it in the night deposit box. Appendix: ACCEPTING
MONEY AFTER 10:30 PM
The blue out of hours case information form and the blue financial statement are used for both the new
patients and re-admissions. Leave the blue information sheet at the appropriate front desk for computer entry.
1. New Patients
Fill out the blue out of hours case information form and blue financial sheet. Information should also be
recorded in the “After-Hours Admissions” books located in Small Animal Reception.
Case numbers will be assigned by office personnel the next working day.
Write client information on all forms to be used:

Out of Hours Case Information (Blue) Appendix; After Hours Forms

Financial Summary Sheet (Blue) Appendix: After_Hours_Form

History Appendix: History_Exam_Forms

Master Problem List Appendix: Master_Problem

Progress Notes Appendix: Progress_Notes

Fee Estimate Appendix: Fee_Extimate

Financial Information Sheet Appendix: Financial_Information

Other necessary or appropriate forms (Consent for Surgery, Unrestricted Donation, Euthanasia
Postmortem Cremation Release, etc.) Appendix: Consent_for_Surgery
Appendix: Euthanasia_Postmortem_Cremation_Releases Appendix: Transfer_of_Emergency_Case
Appendix: Unrestricted_Donation_Form Appendix: CSU_VMC_CPR_Directive
The client must sign the admission authorization section on the second page of the admittance paperwork.
Enter patient in the LA Admission Logbook (3-ring notebook in Small Animal reception desk), under the
correct date for that admission, print or write legibly (client's name, attending clinician's name, species, and
admissions diagnosis). Enter Small Animal patients in the SA Admission Log.
If surgery or anesthesia is likely or remotely possible, have the client sign a yellow „Consent for
Anesthesia/Consent for Surgery‟ form. Ask if the animal is insured. If it is, the owner (or if requested the
VTH) must notify the insurance company before any treatment, surgery/general anesthesia can be started.
Get the name, address and telephone number of the insurance company. The insurance company should call
VTH and talk with clinician. The VTH does not bill insurance companies.
A written fee estimate must accompany the record and be completed by the clinician and signed by the client.
This fee estimate is very important since it is the only legal document regarding discussion of charges with
client. Unless it is updated with new charges per client discussions, dated and signed by clinician, a disputed
bill is settled on the basis of the original „Fee Estimate‟ Appendix: Fee_Extimate
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2. Small Animal Adoption Policy
Any adopted animal is by private arrangement and responsibility between the person adopting the animal and
the surrendering owner. The Veterinary Teaching Hospital requires a „Transfer of Ownership‟ form for the
medical record Appendix: Transfer_of_Ownership_Referring_Vet
D. Admissions Examination Procedure
Cases and Appointments:

Each morning check the appointment book for clinician's appointments.

Meet the owner with the appropriate forms and records. Follow problem oriented record. (See Medical
Records section of manual)

Obtain a history. Appendix: History_Exam_Forms

Conduct a physical examination. Appendix: History_Exam_Forms

Formulate a tentative diagnosis and have in mind several different diagnoses.

Formulate a regimen of treatment.

Discuss your diagnosis and treatment plans with the clinician in charge. The above is to include any
diagnostic procedures that might be needed.

If the animal is to be admitted to the clinic have the clinician complete a fee estimate form with the client.
Appendix: Fee_Extimate

If client needs to make financial arrangements, take them to the Business Office before treatment begins.
Health Certificates
Animals being transported out-of-state must meet certain state requirements. Please consult the Interstate
Regulation Manual located in the reception areas. Special care and investigation must be done in advance of
the appointment for anyone requesting an International Health Certificate, the Community Practice Service is
a good resource for this information.
E. Admissions Unidentified Sick and Injured Animals Presented by Larimer
Humane Society or Good Samaritans
The VTH has an agreement with the Larimer Humane Society (LHS) to provide emergency first aid and
treatment to injured dogs and cats found in Larimer County whether presented to the hospital by Society
personnel or a Good Samaritan. The following guidelines are to be followed when treating these animals.
The emergency clinician assumes full case responsibility for all cases presented to the VTH by the LHS or a
Good Samaritan. All cases presented by the LHS must be seen by the emergency clinician.
1. Acceptable Cases for Treatment
Animals presented with severe injuries with no or little chance for survival (e.g., fractured back with no deep
pain) should be euthanized rather than treated. If the EM students determine that an animal should be
euthanized, they must call in the intern or resident on duty to examine the animal and get authorization from a
faculty clinician to perform the euthanasia.
Animals presented to the VTH by good Samaritans are not covered by this agreement unless the Humane
Society is contacted and permission granted prior to treating these animals. Information about where the
animal was found should be noted by the Good Samaritan prior to leaving the animal at the VTH.
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Larimer Humane Society automatically authorizes $120.00 per animal for stabilization and pain relief for
animals with no identification of ownership or for animals with tags.
For authorization of more than the above limits of Society funding for stray animal medical care, call the LHS
personnel. LHS personnel are available to receive calls Monday through Friday between the hours of 7:30
a.m. - 6:30 p.m and Saturday and Sunday between the hours of 7:00 a.m. – 4:00 p.m. Call: (970) 226-3647
(general shelter number).
If after hours, the Shelter Veterinarian should be called first, followed by the Director of Operations and the
Shelter Manager in that order of numbers listed below.
2. Larimer Humane Society Emergency Contact Information
Dave Robinson, DVM
Shelter Veterinarian
303-519-6061
Dave Wintz
Director of Operations
970-213-9534
Stacy Cleves
Shelter Manager
303-265-1551
When an animal is presented to CSU without any indication of a current owner, the Larimer Humane Society
(LHS) must be contacted and the contact noted in the record. The LHS will authorize treatment or euthanasia.
3. Animals with an owner (tags, tattoo, neighbor identification, etc.) that cannot be
reached will be treated as follows:

Non life threatening problems - They will receive standard stabilizing medical care and pain relief (i.e.
fluids, wound care, antibiotics, analgesics, limb splint age, etc.) until owner is contacted or the patient can
be discharged to the LHS.

Life threatening problems - They will receive medical and surgical treatments necessary to save the
animal‟s life while maintaining a concern for the best interest of the animal. Authority to undertake major
diagnostic, medical and surgical procedures must be provided by a faculty clinician and the LHS (afterhours authorization must come from surgery or medicine backup clinician). The animal will be
discharged to the owner or the LHS as soon as possible.

Unknown animals with unresolving life threatening problems and hospitalized for greater than 5 days will
be adopted by a financially responsible person (through the LHS) or euthanized.
If an owner is located and wants to claim their pet they must, first, pay all the costs incurred by the LHS and
provide their personal information. If they refuse to do so we will not recognize them as the owner but will
24
refer them to the LHS. Any client that refuses ownership cannot authorize euthanasia; we will continue to talk
to LHS for care instruction.
4. Financial Limitations for Initial Treatment
Dollar limits for initial first aid treatment and stabilization during the first 12 to 24 hours following any
injured animal‟s presentation to the VTH is not to exceed $120.00 unless authorization is obtained from the
LHS.
5. Follow-up With the Larimer Humane Society (LHS)
Phone contact must be established with LHS within 24-hours of presentation for all cases presented by the
LHS. Authorization to exceed financial limitations can only be granted by LHS. When an animal is
transferred from the VTH to the LHS the following paperwork must accompany the animal:

RTG - complete as for any animal being discharged from the VTH. Medication must be dispensed with
the animal if further treatment is required. Medications can be given up to three times a day (TID) at the
LHS.

Financial Invoice - a copy of the financial invoice should be sent with each animal returning to the LHS.
All clinician inquiries pertaining to veterinary care of "unknown" owned, injured, or sick animals will be
referred to the Larimer Humane Society (phone 226-3647)
6. Raptors
When a raptor is brought into the Veterinary Teaching Hospital we will immediately contact the Raptor
Center. During regular business hours we are to call 297-0398; outside of regular business hours call 2220322. A wards student will place the bird in a cage located outside the Exotics ward. The raptor representative
will determine whether or not they wish to obtain medical care for the bird.
7. Wildlife
If healthy or immature wildlife are brought into the hospital we explain that the LHS has a wildlife
rehabilitation permit and they are set up to take care of the babies. The good Samaritan can take the animal to
the LHS. If the animal is injured and it is during regular business hours the Exotics service will receive them,
if they are not available the triage clinician will take the case in. After hours the emergency wards students
and clinician will receive the case. If rehabilitation is possible we can transfer the case to the LHS, if not they
should be euthanized promptly. We do not receive bats, venomous snakes, skunks or raccoons.
Under no circumstances will such animals be adopted from the CSU James L. Voss Veterinary Teaching
Hospital or utilized for research.
F. Animals Dropped Off the Night Before an Appointment
An animal dropped off as a convenience to the owner the night before a scheduled appointment will be
charged a day‟s board. This must be preapproved by the clinician in charge of the case. A history and
physical should be done by admitting student and clinician on duty if the owner does not plan on being
present for the appointment. An emergency fee is not charged. The case needs to be associated with a
clinician prior to admission.
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G. Dismissing Large and Small Animal Patients
The Business Office hours are 7:30 am - 5:30 pm Monday through Friday.
No patient may be discharged without a dismissal order given by the attending clinician.
No animal that has been hospitalized overnight may be dismissed without a “Dismissal Form” (RTG).
Appendix: Dismissal_Form The Dismissal form must be reviewed and approved by the clinician on the case.
After calling the client to notify them that the animal is ready to be picked up, place the financial summary
sheet, the RTG and the remainder of the record in the basket at the Business Office window. If the record
must be completed, the clinician will be notified by Medical Records. Arrangements must be made through
the pharmacy for any medications that are to be sent home with the patient. Please indicate on the
invoice/RTG where the animal is located and who will be dismissing.
Unless previously arranged with the Business Office, all charges must be collected at the time the patient is
dismissed. The clinician may assign a teaching credit where it is indicated. Payment in full is expected at
dismissal via cash, check or credit card (VISA, MasterCard, Discover, American Express and Care Credit). If
a fee estimate exceeds $250.00, a deposit of 1/2 the amount is required at the Business Office prior to the
treatment of the animal. The balance is due at dismissal. Appendix: Dismissal_Form
EVERY CLIENT MUST BE BROUGHT TO THE BUSINESS OFFICE PRIOR TO LEAVING THE HOSPITAL
TO RESOLVE ANY FINANCIAL OBLIGATIONS. ANIMALS SHOULD NOT BE BROUGHT UP TO THE
CLIENT UNTIL THE FINANCIAL PROCEDURES ARE COMPLETE!
Animals must be groomed if indicated.
Patients being dismissed have priority over those being admitted, with the exception of emergency cases.
The client should be instructed to contact the receptionists for any follow-up appointment, suture removal or
recheck examinations.
H. Dismissing Patients After-Hours
Charges must be filled in by the clinician on duty.
Record must be signed by the clinician, student and accompanied by the RTG form if the animal has spent at
least one night in the hospital.
Unless previously arranged with the Business Office, all charges are to be collected at the time the patient is
dismissed. Fill out an Interim Receipt according to the instructions. Place the payment and copy of the interim
receipt in an envelope; put it in the night deposit box. The record, including the financial sheet should be
placed in the basket at the Business Office window.
Cashiering Procedures - There is a booklet with specific instructions located on the small animal reception
desk. It explains the cashiering of out-of-hours procedures in detail.
26
I. Disposal of Animals
All animals that die or are euthanized at the Veterinary Teaching Hospital, for whom cremation arrangements
are not made by the owner, undergo disposal through the Veterinary Diagnostic Laboratory Thermal-Alkaline
Digestor.
Values of large animal donations are based on current market price.
We refer owners to their accountant for an actual dollar amount of the claim.
J. Donation (Patient/Non-patient Animal)
Only owners or their agents can give authority to euthanize or donate an animal. If the authority is given by
telephone rather than signature, a third party must witness the call. Both parties must then sign the donation
form.
Animal donation requires completion of the Unrestricted Donation form, and a Bill of Sale and Brand
Inspection for large animal donations. Appendix: Unrestricted_Donation_Form
The donation of animals for teaching purposes is allowed, but should be cleared through appropriate
clinicians. All animals received are donated unconditionally. There is no donation fee.
VTH donations can only be accepted by the coordinators as listed below. An unconditional donation form
will be used. USDA requires that the driver's license and vehicle license numbers be obtained from
individuals donating animals. No small animal will be sold from CSU, as we are not a USDA licensed seller.
(We are a USDA licensed buyer). Each donation needs to have a clinician on record that will be responsible
for the animal‟s care.
Food Animal: Dr. Rob Callan
Equine: Dr. Baxter and Krista Dickinson (equine donation coordinator).
1. Large Animal Donations
Contributors will be advised of the following:

The animal will be used as a donation for teaching purposes with animal to be euthanized and
disposed of at termination of utilization.

The animal will be used as a donation for teaching purposes with sale (large
animal) or adoption
of the animal when deemed appropriate by the Veterinary Teaching Hospital (proceeds from sale will
be used to support the hospital teaching programs).

The animal will be used as a donation for teaching purposes.

The animal (large animal) will be used for research when specifically designated by donor.
27
Donation of Animal

Donor will be contacted by equine donation coordinator.

Inform the owner of our policy regarding donation.

Complete the Unrestricted Donation form and obtain brand inspection (large animal) from
owner/agent.

Every large animal donated to the VTH must be accompanied by a Bill of Sale.

Papers will be sent by Certified Mail for signing and return if donation is made over the phone.
2. Small Animal Donations
The VTH does not accept small animals as donations from owners wishing to relinquish ownership.
K. Euthanasia - Postmortem – Cremation
Animals for euthanasia require completion of the Euthanasia/Postmortem/Cremation Release form.
Euthanasia will take place immediately after authority is received unless other arrangements are specifically
made between the clinician handling the case and the owner and
described as Special Instructions on the Release. The animal will be euthanized according to the instructions
of the release. The clinician will complete that portion of the release relating to date and time of euthanasia.
Forms may be obtained from the Business Office. The attending clinician is responsible for completion of the
form. It should be filled out in its entirety and placed in the medical record.
1. Animals that are in the Hospital

Complete the Euthanasia/Postmortem/Cremation/Release Form.
Appendix: Euthanasia_Postmortem_Cremation_Releases

Answer completely all questions on the form and make sure it is imprinted with the blue card and that it is
signed by owner and witnessed.

Place the signed release and Brand Inspection (for large animals) with the financial portion of the medical
record.

Complete and total charges as of the date of the release. The owner will pay these as if the animal were
being dismissed from the Hospital.

The medical record with the releases will be routed the same as a regular patient.
2. Re-entry of Previous Patients for Donation for Euthanasia

Obtain the old medical record.

Complete the Euthanasia Release as above.
28

Charges: If the previous clinician has requested the animal be returned and necropsied for teaching
purposes, or if the patient is currently under treatment, no charge will be applied. For other euthanasia
situations, charge the regular euthanasia fee.

Put white and yellow copies of the signed Release in the medical record. The small animal owners get the
pink copy.
3. Disposition of Animals Within VTH
We identify three categories of animals within the VTH for charging/accounting purposes:
a. Client Animals
Client animals are accounted directly to the owners.
b. CSU-VTH Animals
This category includes donations that are assigned as VTH animals.




Unconditional donations - (see Animal Donation section)
Animals purchased for laboratories
Permanent animals (including blood donors/teaching animals)
Cases that become donations but require specific clinical follow up.
All CSU animals must be reclassified within 5 working days to VTH laboratory, VTH permanent,
research animal or to be disposed of by euthanasia or sale.
All donations to the VTH should be admitted as appointments during regular working hours only. All
animal donations must be assigned a USDA number within 24 hours.
No "special arrangements" are allowed for animals donated to the VTH (e.g. surgery performed, and if
successful, the owner will buy back the animal; and if surgery is unsuccessful the owner pays nothing).
Disposition of VTH donations (See Animal Donation section)
All equine and bovine VTH donations must have an official Colorado brand inspection certificate.
VTH animals will not be used or euthanized without the approval of the appropriate coordinator.
c. Research Animals
This category includes all animals purchased for funded research projects. All research animals must
have a case number, fund number and clinician‟s name.
L. Hospitalization
1. Large Animal
Find a clean stall. If you move an animal already in a stall to make room for a new patient, make sure the
records and stall card are moved with the animal.
Send all owners equipment (ie: halters, lead ropes, blankets, wraps) home with them at time of drop off, if
left, equipment should be marked with white tape with owner‟s name (blankets, wraps) and placed in a trash
29
bag that is labeled with owner‟s name too. Owner‟s halter and lead ropes should be taped together, labeled
with owner‟s name and hand at stall side. Use VTH halter and lead rope while patient is in our care. Horse
shoes pulled from patient prior to surgery or procedure need to be bagged, labeled with owner‟s name and
hung at stall side.

Bed stall with 1 bale of straw, unless on cement then 2 bales. The mare foal
Stalls receive 1 ½ bales of straw. Cardboard is used in the colic aisle stalls with
2 bags. Please use matted stalls first. Do not use double stalls unless instructed by clinician, resident
or technician. Please ask nursing staff for assistance before placing a horse in a stall. Certain aisles
will house certain cases based on their chief complaint.

Place stall card bearing client/patient information on the stall. Appendix: Stall_Card

Provide clean water.

List feeding instructions on the stall card for the barn crew.
2. Small Animal
Client beds, blankets, collars, and leashes must go home with the owner (they get lost, soiled and may become
contaminated).
Find a clean cage in a designated ward, i.e., Medicine Ward 1 & 2, Oncology Ward 3, Surgery and Neurology
Ward 4 & 5.
Fill out cage card completely with pertinent information such as client/patient, clinician, student, weight, and
feeding instructions.
Place cage tags on cage with important information for animal care attendants, i.e., no food, blanket at all
times, student will feed, etc.
Note: Students are responsible for feeding their own patients.
Provide fresh water unless animal is likely to fall into water dish and become incapacitated (Seizures,
depression, anesthetized).
If the patient dies, immediately notify the clinician in charge of the case - DAY OR NIGHT.
M. Re-admissions (Rechecks or prior patients with new problems)
Every visit or reentry to the hospital must be reported to the appointment desk prior to any examination or
treatment.
Patients previously admitted to the hospital will have a case number and prior medical record. The medical
record should be requested from the Medical Records Office. "Out Slips" are located in the LA and SA
reception areas and Medical Records. If you remove a record from Medical Records, you must fill out an out
slip. You may find the case number of a patient previously seen by the VTH by accessing the client‟s account
and animal name in the computer system.
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N. Referral Clients/Patients
Referral cases are necessary and are encouraged. In addition, the "routine" type case is also necessary for the
needs of our teaching program. The role of staff and faculty are defined as follows:
1. Appointments – Scheduling
Clients must be instructed to make appointments through the large and small animal desk from 8:00 am to
5:00 pm.
2. Role of Receptionists
When a referring veterinarian calls for an appointment, the receptionist will ascertain to whom or which
service team the patient is being referred. The receptionist will advise the referring DVM to forward a
Referral Form or letter and pertinent records (including radiographs) either prior to the appointment or send
with the client. Appendix: Patient_Referral_Information
When a client calls and reports he/she has been referred to CSU, the receptionist will make the appointment
and ask the client to have their DVM complete a Referral Form or letter and bring it with pertinent records
(including radiographs) to the appointment.
Every client admitted will be asked who their regular DVM is, and if this animal has been referred. Hospital
record will reflect name, address and phone number of the referring DVM on all referral cases. A referral
letter will be mailed to the referring veterinarian.
Occasionally, non-referral clients will call to make an appointment. The appointment will be scheduled. Our
policy is to encourage referrals, but not to refuse service to any potential client.
Walk in cases during regular hours (8:00 am - 5:00 pm weekdays) without an appointment will be charged a
nonscheduled fee. After-hours (5:00 pm - 8:00 am weekdays, holidays, and weekends), an emergency fee
will be charged.
When all appointments and emergency facilities are filled, emergency patients are referred to a private
practice specialist. A list of private specialists is located in the reception area.
3. Role of Clinicians
Clinicians should make every attempt to accept cases referred to him/her. Faculty will be responsible for
referral cases. The clinician must inform the referring veterinarian of case outcome. If the client is referred
back to the rDVM for treatment and/or further evaluation, that veterinarian must be contacted prior to time of
client's appointment.
If a patient dies and is necropsied, the clinician must inform the referring doctor of tentative necropsy results
by phone and indicate that final necropsy report will be forwarded when it is received. Methods of notifying
referring doctors:

CSU referral response letter. (completed by staff)

Phone call (to be followed by formal letter) at time of dismissal and used for all deaths.
31



Formal letter (at time of dismissal).
Case dismissal form (completed by staff, student and clinician)
Generally, the handling of referred cases by interns/residents is to be discouraged but if an intern or
resident should handle a referred case, the referring doctor should be notified by formal letter. The letter
must be checked and signed prior to mailing by the "team leader" (permanent faculty) that is responsible
for the intern/resident.
If a referring DVM calls after hours regarding the status of a case currently in the hospital, the intern or
resident on duty should be consulted. In the event there is not a clinician available, ask the referring DVM to
call the next morning for the assigned clinician.
4. Role of Medical Records
Upon receipt of records from the Business Office, referral cases will be returned immediately to the clinician.
Those cases awaiting final necropsy report will also be returned with a preliminary report. The clinician may
indicate on the record that medical records should send the final report to the referring doctor.
5. Minors, Animals Submitted By
Animals presented at the large animal or small animal reception desks by children under 18 years of age are to
be informed the animal cannot be treated unless authorized or accompanied by an adult. This can be
circumvented by calling the adult concerned and having a witness listen in to confirm permission to treat and
listing the adult as the owner/responsible party. A faxed signature is acceptable also.
6. Personal Animals – Students or Employees
Students or employees must open an invoice for their personal animals. All transactions must be recorded in
a proper medical record. Students will be eligible for a discount in accordance with the CSU VTH Policy.
Appendix: Outpatient_Day_Fee
7. Referrals to Other Practices
On occasion callers may request referrals to other specialty practitioners or allied health professionals. As a
public institution, the VTH cannot provide preferential recommendations to clients for referral to outside
practices for veterinary medical care, or to businesses that provide grooming, boarding, hospice care,
cremation or other allied pet care services. Appendix: VTH_Referral_Policy
32
IV: Clinical Assignments
A. After-Hours and Weekend Duty including „On-Call‟
Responsibility for operation of the VTH during the night and on weekends lies with the duty technician, duty
interns, duty residents, backup faculty, and the junior and senior veterinary students assigned for after-hours
duty. The VTH is open for emergencies 24 hours each day, every day of the year.
Student duty assignments for each service are outlined in the individual service sections of this manual.
There is apparently some confusion about student required availability for clinical duties which involve
responding to emergencies (including, but not limited to Equine Ambulatory, Equine Barn Back-up Pager
duty, or Small Animal Wards, as examples).
When a student „On-Call‟ is needed (1) the contact phone number listed with the VTH (and ONLY that
number) will be called, and (2) the student will have ~20 minutes to reach the hospital.
Throughout the last year, our after-hours and emergency doctors and staff experienced incidents where
students could not be contacted, or they could not respond in an appropriate amount of time. There seemed to
be general confusion involving the incorrect idea that these students only needed to find and carry
some VTH-issued pager, and that the receptionist would then know how to reach them.
Students are asked to please be certain to have provided a functioning contact telephone number through
which they will absolutely be reachable when assigned to "on-call" duty. Students also are to be certain that
they are within ~20 minutes travel time when on-call so that they can respond promptly to the need for their
assistance.
B. Clinical Assignments
Students are not allowed to sleep while on night duty or emergency medicine assignment.
Each section specifies assignments for all clinical rotations, including weekends. Assignments for 4th year
students are for seven days each week. Students should check with individual sections as to specific time
requirements.
Absence from clinical assignments requires prior approval from the faculty member in charge of the
assignment. Unapproved absence must be made up through arrangement with the instructor in charge of the
assignment. Failure to do so may result in an F for that assignment and require repetition of the entire week.
College policy allows students to be excused from clinical rotations for state board examinations and/or job
interviews. Students are allowed one day of excused absence for personal leave or illness (not one day for
each) in any one Senior Practicum rotation (not one day per week). More than one day of excused absence
from a rotation will require the student to develop and implement a plan, in consultation with the
Instructor/Clinician and the senior practicum coordinator, to make up the missed work or to repeat the
rotation. It is the student‟s responsibility to contact and submit appropriate documentation to the Clinical
Sciences Departmental Office designated for administration of attendance records for their year in the PVM
Program, which in turn will provide certification to the Instructor/Clinician whose class must be missed.
Clinicians and section heads may deny time off if they feel your presence is required to cover the service.
33
Individuals utilizing more than these days will be required to make up the missed clinical rotations using their
scheduled vacation time or after graduation. It is not possible to make up missed clinical assignments during
holidays or repeat week assignments. Weekend and night duty assignments are the responsibility of the
person assigned, and the student must make arrangements for another student to take his/her place if he or she
is unable to fulfill the assignment. Please refer to the PVM Class Attendance Policy for more details on the
protocol for obtaining excused absences.
Appendix: PVM_Class_Attendance Appendix: PVM_Excused_Absence_Request_Form
C. Clinic Rotation Rounds Rooms Appendix:
Floor_Plans
Small Animal Rotations
Anesthesia ......................................................................................................B108
Argus .............................................................................................................. 117
Cardiology .....................................................................................................C120
Clinical Pathology.......................................................................................... C102A
Community Practice ......................................................................................B119A
Critical Care Medicine (including Intermediate Care) ..................................C103B
Dentistry.........................................................................................................B111
Dermatology ..................................................................................................C101
Diagnostic Imaging (Radiology) ..................................................................G113A&B
Exotics
............................................................................................... A120
Internal Medicine A .......................................................................................B101
Internal Medicine B .......................................................................................B107
Neurology ......................................................................................................B105
Oncology........................................................................................................B104
Ophthalmology .............................................................................................. A123
Postmortem Investigation ..............................................................................F100, F100A
Small Animal Surgery Lab ............................................................................D107B
Spay/Neuter ...................................................................................................D107D
Surgery A (Small Animal) .............................................................................B102
Surgery B (Small Animal) .............................................................................B102
Large Animal Rotations
Calving Management .....................................................................................Dr. Mortimer
Equine Field Services ....................................................................................LA Reception
Equine Medicine ............................................................................................ Barn
Equine Reproduction .....................................................................................Stallion Lab-Foothills
Equine Surgery .............................................................................................. Barn
Food Animal Medicine ..................................................................................Barn 135A
Food Animal Field Services ..........................................................................LA Reception
Lab Animal ....................................................................................................Painter Center
Large Animal Anesthesia...............................................................................Barn
Large Animal Surgery ...................................................................................Barn
34
D. Clinical Projects (Special) - Elective Rotation
A student has the option to design, as an elective week, a comparable clinical experience or research project
on a subject of special interest that is not available in the PVM curriculum. All special clinical rotation
projects must have prior approval from the instructor in charge, Senior Practicum Coordinator, or in his/her
absence, the Associate Dean for the PVM Program. Please refer to the PVM Independent Study Policy for
additional details. Appendix: PVM_Independent_Studey_Approval_Form
E. Emergency Phone Call Duty
Students are expected to be able to communicate effectively with owners who call the VTH regarding
potential emergency conditions in their animals. The caller may have little medical knowledge, and if new to
animal ownership, may know little about normal vs. abnormal animal behavior with regard to clinical signs of
illness. In addition, the caller may be emotionally distraught and incapable of communicating effectively.
Please exercise patience, speak as plainly and concisely as possible, maintain a friendly demeanor, and
convey your shared concern for the caller‟s animal. Make every effort to identify the chief medical
complaint, obtain a brief history, and determine the medical condition of the animal as best as possible. As a
matter of patient advocacy, please try to assess the problem(s) before providing financial information, unless
the owner first requests information regarding the potential costs associated with emergency treatment. By all
means, attempt to be accurate in your representation of the potential costs, and if it appears emergency service
may be declined, though it is indicated, please encourage the caller to seek medical attention as soon as
possible, even if it will be at another veterinary hospital. The actual decision whether a call from a client
about an ill animal represents an actual emergency rests with the intern or resident on duty. If the client
wishes to have an animal examined and is prepared to pay the emergency fee, even if it is determined that the
case is not of an emergency nature, we will see the animal.
F. Grading Policy for VM786BV “Senior Practicum”
Each rotation for the Senior Practicum is an assignment that must be fully attended and mastered. Each
faculty member or resident responsible for a Senior Practicum rotation will complete a online evaluation of
performance for each student, and assign a grade. The critique and grade is submitted to the Senior Practicum
Coordinator no later than two weeks after the end of the rotation for which the grade is given. An unexcused
absence or unsatisfactory performance in one rotation would be the basis for a "U" grade, and require makeup.
A second unexcused absence or unsatisfactory performance (“U”) would be the basis for an "F" grade for the
semester and lead to academic dismissal. The Senior Practicum Coordinator will record the grade and return
a copy of the evaluation to the student within one week of receiving it from the faculty member. Repetition of
a Senior Practicum rotation may be required to resolve the "U" grade, but if next opportunity to participate in
that rotation occurs more than 30 days following the last official instructional day of the semester, the student
and course coordinator must create a written agreement no later than 30 days following the end of the
semester that defers resolution of the "U" until the rotation can be repeated.
G. Interns and Residents - Small Animal
The intern or resident on emergency duty is the person of authority and responsible for efficient and safe
function of the small animal portion of the hospital. If any serious problems occur during the shift the
appropriate faculty back-up clinician should be notified immediately.
The emergency duty intern or resident is required to be present in the VTH from 5:00 pm – 7:00 am on
weekdays, and on weekends and holidays from 7:00 am until 5:00 pm for the day shift or 4:30 pm until 7:30
35
am for the night shift. Sunday-Thursday overnight interns should stay until all cases in their care have
complete treatment orders and have been formally transferred to an appropriate service. If representatives
from receiving services are not available, transfer forms can be left in rounds rooms and the CCU faculty
informed of the planned transfer. The intern and resident emergency duty roster will be posted in the reception
offices and the small animal Critical Care Unit. The person on duty will post their beeper number and phone
number on the blackboard in CCU.
Prior to beginning an emergency shift the intern or resident should assemble the students assigned to wards
and receiving duty and insure that they are oriented as to their responsibilities. The student duty roster is
posted in the reception offices. The emergency intern/resident must meet with a CCU faculty clinician or
resident at 5:00 pm Monday through Friday and 7:30 am weekends and holiday to discuss critical cases and
incoming emergencies.
Other Responsibilities of Duty Intern or Resident

Any unauthorized individual (without a VTH badge) found beyond security doors should be asked to
leave the hospital. Campus security should be notified if unauthorized individuals will not leave, are
causing problems, are considered to be a threat, or if theft is suspected.

The wards and receiving students shift is 5 pm to 7 am, however the goal is to allow the students to leave
at 11:00 pm (or thereabouts) if all the cases are properly taken care of, the emergency clinician may
release students and call them back into the hospital if necessary.

The intern or resident on emergency duty is responsible for evaluating students‟ performance on wards
and receiving and must report any concerns to the faculty of that student‟s rotation.

Before calling in a radiologist to perform an ultrasound or a clinical pathologist for cytology on an
emergency basis this must first be approved by the faculty backup person.
Backup Faculty Assistance
Each week a faculty and/or resident from each service area is assigned to backup duty. A schedule is posted in
the reception areas. The duty person should utilize the backup faculty member to obtain advice and assistance
in emergency cases. Interns should use their resident backup if the number of emergencies is likely to result in
delay in providing emergency care to critical cases.
H. Items to Carry With You
Stethoscope, penlight, thermometer, bandage scissors, and clipper blades (#40) are standard student
equipment. See each service section of manual for additional required equipment.
Appendix: Equipment_and_Apparel_Requirements
I. Practicing Veterinary Medicine
It is illegal for students to engage in the practice of veterinary medicine in any form unless they are under the
direct supervision of a veterinarian. Failure to observe this rule may result in dismissal from the College of
Veterinary Medicine and Biomedical Sciences. Non-supervised veterinary practice on the part of students is
in direct violation of all states‟ Veterinary Practice Acts.
36
V: HOSPITAL SERVICES PATIENT SERVICES
1. Anesthesia
Tips to Help Both You and the Patient Survive
Monday
Tuesday
7:30 a.m.
Prep room
8:00 a.m.
Prep room
7:30 a.m.*
Thursday
Friday
8:00 a.m.
8:30 a.m.
9:00 a.m.
First week: orientation
By 5:00 p.m. on the first Monday of the rotation you
must have passed the computer test with a score of > 70%
Second and Third week: SOAP cases
Prep room
Have all SOAPS approved by faculty or
Wednesday
staff between 7:30 and 8:00 am.
Draw non controlled premedications and
anesthesia induction agents and maintenance agents, and
leave labeled syringes for controlled drugs so a staff
member can get that for you. Set up equipment for first
case.
Please be in your scrubs prior to rounds.
ROUNDS
Lecture topics may include:
- mechanical ventilation
- oxygen flow rates
- blood gas interpretation
- pain management
- case discussion
- questions or assigned articles
Technicians will administer premedications
to the first wave cases.
Rounds will end each day at 9:00 a.m. By
9:30 a.m., each “first wave” patient must be
catheterized, induced, intubated, instrumented and ready
for the surgery student to clip for surgery
* It may be necessary to arrive prior to 7:30 a.m. in order to adequately prepare for the day prior to the start of
rounds.
Assignment of Cases
Cases may be assigned to you or you may be given the opportunity to select your own. You are expected to
express your preference to the scheduling coordinator or anesthesia faculty for cases before 3:00 pm each day.
Check the schedule board in the prep room often for cases and assignments. All cases for the following day
37
MUST be signed up for prior to any student leaving for the day.
Examine your animal and prepare your SOAPS the night before. You must thoroughly
examine the animals‟ hospital records, discuss the care with the referring service and be knowledgeable of
any problems the patient has and how it may affect the anesthetic procedure. Any questions regarding
appropriate clinical and laboratory work up should be addressed the evening prior to anesthesia. Always
examine the patient yourself and obtain the patient‟s temperature, pulse and respiration yourself the night
before. You are expected to be punctual in all aspects of anesthetic delivery and care.
Learning Objectives
Understand advantages, disadvantages and pharmacologic action of the major anesthetic agents used in
domestic animals.
Be able to assess depth of anesthesia regarding patients under your care.
Be able to use and discuss all the equipment available including anesthesia machines, rebreathing and nonrebreathing circuits, monitoring equipment, syringe pumps, ventilators and accessories. Understand the
function and application of these devices.
Minimum Data Base
Variations specific to a case may be permitted by the attending anesthesiologist after consultation.
Small Animals
Non-Elective Surgery: history, physical, CBC, UA, serum chemistries
Elective Surgery: Patients under 5 years: history, physical, PCV, TSP, urine specific gravity. If patient is less
than 3 months old blood glucose should also be obtained
Patients over 5 years: history, physical, CBC, UA, serum chemistries
Primary service clinicians or students are responsible for supplying the minimum data base.
You are responsible for checking the minimum data base and assessing the need for additional information
such as more blood work, ECG, radiographs, blood gases, etc. before SOAP and anesthetic plan is completed.
This assessment should be done the evening prior to anesthesia.
Large Animals
Non-Elective Surgery: history, physical, CBC, chemistries if indicated
Elective Surgery: history, physical, CBC or at least PCV, TP, chemistries as needed
Primary service clinicians or students are responsible for supplying the minimum data base.
You are responsible for checking the minimum data base and assessing the need for additional information
such as more blood work, ECG, radiographs, blood gases, etc. before SOAP and anesthetic plan is completed.
This assessment should be done the evening prior to anesthesia.
38
Fluid Administration Rates
5 – 10 ml /kg/hour for most patients
Administration rates may be changed after consulting with the faculty or staff if the case warrants
Selection of Anesthetic Agents
Many different anesthetic plans may be appropriate for an individual case. Choose a plan that you think will
be most beneficial for the patient. Try to gain experience with the basics and then use a variety of different
patient appropriate methods during your rotation. Be able to explain and justify your selections.
Beware of bottle doses - check the anesthesia handbook, or consult with the staff for appropriate doses.
All syringes must be labeled.
Monitoring
Never Leave an Anesthetized Patient Unattended. In addition, someone should always have an hand on a
patient during transport and recovery to prevent accidental injury with sudden patient arousal
Monitor respiration, heart rate, arterial blood pressure, palpebral reflex, eye position, jaw tone, and color
continuously; record heart rate, respiratory rate, arterial blood pressure, ETCO2 and O2 saturation every five
minutes.
Recovery
Deflate the cuff of the endotracheal tube when the patient no longer requires supplemental oxygen (unless
specifically asked not to do so as in the case of bloody upper airway surgery).
Leave the endotracheal tube in brachycephalic breeds as long as possible.
Be sure the swallow reflex has returned to the patient before removing the endotracheal tube.
Horses are typically extubated only after they stand.
Take and record a post-op temperature.
Place recovering patients in a heated cage. Patients with a temperature < 96oF may also need a circulating hot
water blanket, Bair hugger or heat lamp. Large dogs or active patients in heated cages must have their
temperatures rechecked every 30-45 minutes to avoid hyperthermia.
Stay with the patient until it is extubated (or standing, for horses).
In routine small animal cases remove the IV catheter once they are extubated and in sternal recumbency. If in
doubt, leave the catheter in longer.
Periodically continue to check on the patient and make sure it is comfortable, has been taken outside (SA) if
necessary, etc. Please bring any concerns about patient well being to the faculty or staff.
Cleaning Up
It is your responsibility to clean as you go: counter tops, surgery areas, recovery cages and the floor of the
prep room.
39
All breathing bags, hoses and endotracheal tubes are to be rinsed and disinfected in the prep room sinks.
Endotracheal tubes are to be cleaned inside and out prior to soaking in NolvasanR solution. Do not leave Bain
Circuit rebreathing bags soaking in Nolvasan.
Do not clutter the preparation room with books, binders, backpacks, etc. Backpacks MUST be placed in
cubbies designated for the same in the anesthesia rounds room. Computers and other materials should NOT be
left on the table when not in use.
Scavenging Waste Gases
Waste gas scavenging interfaces that attach to the hospital vacuum lines are provided on all anesthetic
machines. These devices are to be used at all times.
Record Keeping
Fill out SOAP's and anesthetic records completely, have SOAP's approved by faculty or staff at 7:30 am
Keep each patient‟s hospital record and anesthesia record with the patient at all times.
All controlled substances MUST be logged on the anesthesia record and excess drug wasted or transferred to
the CCU in the presence of a staff or faculty member.
The record should be copied for patients going to CCU and the original placed in the file which is located in
the anesthesia prep room.
Equipment
Have all anesthetic gas machines and monitoring equipment set up and ready prior to induction.
Please turn off oxygen and monitors at the conclusion of the procedure and help with cleaning and
disinfecting the same. All equipment should be clean and stored in an orderly fashion.
Patients weighing 5 kg or less generally requires a non-rebreathing system (Bain system). The O2 flow rate
for the Bain system is 200 ml/kg/min with a minimum flow of 1 liter.
Catheters and Fluids
Use aseptic technique for placement of catheters by washing hands, prepping catheter sites and not
contaminating that portion of the catheter that will be in the vein.
IV catheters are to be placed prior to anesthesia induction in all patients except very small exotics, pot bellied
pigs, cat castrations and cat declaws.
If you are unable to catheterize the vein on your first attempt PLEASE request a staff or faculty member to
place the catheter. DO NOT make a second attempt unless approved by the faculty member on duty.
Mini-drip sets are available for use with fluids. Mini-drip sets should be used on patients weighing less than 5
kg. Syringe pumps are recommended for fluid administration in patients weighing less than 2 kg.
Normosol (large animal) or LRS (small animal) are used for most cases and is kept in incubators. Other types
40
of fluids are available from the pharmacy and may be used where indicated.
After Hours Duty
Divide responsibility among seniors and sign up on sheet provided. After the schedule is completed it will be
posted at the small animal front desk.
Keep the front desk aware of how you can be reached during your duty rotation.
When on duty take over any anesthetized patient after 5:00 pm.
When on duty you must be within twenty minutes of the VTH.
You must complete your on-call duty to obtain a completed grade for the rotation.
Tests
A computer based 25-question multiple choice test on basic anesthesia must be completed by 5 pm on the
Monday of the first week of the rotation. You must score at least 70% on the test before you can commence
anesthesia on clinical patients after this time. A second test will be taken at any time in the third week. You
must pass the test with at
least a 90% score during the third week to obtain a completed grade for the
rotation.
Student Evaluations are based on:

Test scores (passing with 70 and 90%)

Knowledge of cardiopulmonary physiology, administration of inhalant anesthetics, and the pharmacology
of anesthetic drugs

Application of knowledge to the administration of anesthesia.

Assessment of anesthetic depth and ability to establish an appropriate plane of anesthesia.

Ability to recognize trends in the anesthetized patient's monitored parameters, and respond in a timely and
appropriate way

Competence in catheterization, intubation and understanding and use of anesthetic equipment.

Pre-anesthetic interpretation and evaluation of patient's history, lab data and existing or needed diagnostic
tests

Completeness, accuracy, and effort in SOAP sheets and anesthetic records.

Attendance and participation in rounds

Completion of your after hours commitment
B. Cardiology Service
Cardiology is a full time clinical specialty service within the Veterinary Teaching Hospital. Faculty clinicians
share equal clinical coverage of the cardiology service with support from resident(s), post doctorate(s) as well
as support staff. Each week, the cardiology service sees scheduled clinical appointments of small animals
with cardiac problems. In addition, the service is available for internal referral of small animal cardiac cases
from other services including the night-emergency and triage services. The cardiology service provides inhouse echocardiography, electrocardiography, and cardiac consultation services for small, large, and exotic
animals.
In addition to the standard cardiology services mentioned above, specialty activities such as interventional
41
cardiology and cardiothoracic surgery are performed on the cardiology service. Interventional cardiac
procedures include diagnostic cardiac catheterization, balloon valvuloplasty, electrophysiological
studies/procedures, and other catheter-based interventional procedures. Cardiothoracic surgery includes openheart surgery.
Students electing to take this rotation will participate in the diagnosis and medical management of cardiac
cases. Emphasis is placed on developing physical examination skills including auscultation. Training is
received in electrocardiography and echocardiography. Students will also have the opportunity to participate
in advanced cardiovascular techniques such as cardiac catheterization and cardiac surgery.
Objectives:

To systematically evaluate the cardiovascular system on physical examination, and to recognize abnormal
findings.

To list differential diagnoses for abnormalities noted on the history and cardiovascular exam.

To recognize the presence of abnormal heart sounds (murmurs, transients, and arrhythmias).

To understand the pathophysiology, clinical features, management objectives, and prognosis of the cardiac
lesions in the patients seen on the service.

To understand the basics of ECG, echo, and Doppler interpretation.

To understand the treatment of congestive heart failure.

To have fun and to appreciate the complexity and logic of the cardiovascular system!
Daily Schedule
Rounds: Mon through Thursday 8:30 a.m., Student grand rounds: Fri 8:30 a.m.
Clinical appts: Monday 9:00 a.m.; Tuesday and Thursday 9:30 a.m.; Friday 10:30 a.m.
Emergencies/consults: (essentially any time)
Rounds Presentations

Be prepared to present all cases seen the previous day.

Bring radiographs and copies of lab work to rounds for presentation.

Review appropriate literature prior to presentation

Present case: History, PE including auscultation and BP, ECG, Radiographs, Echo, Assessment, Rx
recommendations
Recommended References
Fox et al: Canine & Feline Cardiology, 2nd edition
Braunwald: Heart Disease: Textbook of Cardiovascular Disease 5th edition
Kittleson & Kienle: Small Animal Cardiovascular Medicine
Tilley, Smith, Oyama, & Sleeper: Manual of Canine and Feline Cardiology 4th edition
Boon: Manual of Veterinary Echocardiography
Orton: Small Animal Thoracic Surgery
42
C. Community Practice
Community Practice is intended to emulate private practice as much as possible within the confines of the
James L. Voss Veterinary Teaching Hospital. The schedule will include elective surgery (spay, neuters, etc.),
dentistry, preventive health appointments and any non-referred, non-emergency medicine appointments.
Emphasis is placed on quality, efficient case management and client education. This is a four-week core
rotation for small animal track students. General track students are required to participate in one week of
CP-elective surgery and one week of CP-medicine.
Community Practice provides a unique hands-on experience. You will be assigned to cases that will be yours
for the duration of the rotation. Dentistry, surgery and medical procedures will be performed in the mornings.
Medicine appointments and receiving will occur during the afternoons. Students will be responsible for all
client interactions, accurate fee estimates, animal care and appropriate diagnostic plans and treatments. While
all plans need to be cleared with the veterinarian on the service, students are responsible for the development
and implementation of all diagnostic plans and veterinary care in a timely manner. Students are also
responsible for all information calls received at the hospital until 5:00pm. Common problem differentials and
fee estimates are provided in a notebook available to the student during the rotation.
Please remember to follow the hospital dress code while on service. If you have any questions or concerns
about the overall service, please contact Dr. Ruch-Gallie (pager 373 or rgallie@colostate.edu). Questions
about the individual components (medicine, dentistry, surgery) should be directed to the doctor on service.
Schedule
You will receive a personalized first day schedule in your mailbox prior to starting the rotation. The first day
of the rotation will include a dental lab, orientation and receiving for the following day‟s cases. Students will
be separated into two groups for the dental lab with half participating in the am and half in the afternoon.
When not in the dental lab, you will be receiving your cases for the following day. All students will be
starting at 8:00am this first day.
For the remainder of the rotation, surgery and dentistry receiving starts at 7:30am. Dentistry, surgery and
medicine procedures will be performed in the mornings. Medicine appointments will begin at 1:30pm. There
will be no medicine appointments on Fridays. However, we will be conducting the Preventive Health Clinic
on Saturday mornings. The following chart summarizes the overall schedule. Remember, not all students
will be present for the whole day every day!
43
Monday
7:30am
dentistry and
surgery
receiving
8am medical
procedures
and
anesthesia
9am floating
student
Tuesday
7:30am
dentistry and
surgery
receiving
8-9 roundsdentistry
12-1 roundsmedicine
1:30-6:30pm
medicine
appointments
and rechecks
9am floating
student
1:30-4:30pm
medicine
appointments
and rechecks
9am medical
procedures
and
anesthesia
Wednesday
7:30am
dentistry and
surgery
receiving
8am medical
procedures
and
anesthesia
9am floating
student
Thursday
7:30am
dentistry and
surgery
receiving
8am medical
procedures
and
anesthesia
9am floating
student
Friday
7:30am
dentistry and
surgery
procedures
8-9 am
roundssurgery
12-1 roundsopen
1:30-4:30pm
medicine
appointments
and rechecks
12-1 roundsbehavior
1:30-6:30pm
medicine
appointments
and rechecks
9am floating
student
1:20-2:20pm
surgery
rechecks
Saturday
8am-noon
PHPclinics
and surgery
release
9am medical
procedures
and
anesthesia
Rounds schedule All rounds will be held as a group in Room 118 (Argus Institute). In addition, students
with active medicine cases will meet with the medicine clinician between 1-1:30pm for case summaries.
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
12-1pm, medicine
8-9am, dentistry
12-1pm, open
12-1pm, behavior
8-9am, surgery
How to pass (small animal track)
You will be evaluated on your clinical skills, patient care, knowledge and client communication skills. For
each week on rotation, each student will need to successfully complete four medicine cases, one dental
prophylaxis (cleaning), and one each canine OHE, feline OHE, canine castration and one other surgery. All
students must participate in the dental lab. Additionally, each student must also pass (70%) a 20 question,
closed book/note WebCT exam within one week of completing the rotation.
What to Review




all PHP information (see Preventive Health Program)
junior practicum surgery notes and CD
anesthesia notes
dentistry handbook (provided in your mailbox or on-line) and notes
44
For general track and elective students
CP-surgery only students will meet at 7:30am in the surgery induction room. CP-medicine only students will
meet at 1pm in Room 118. CP-dentistry only students will meet at 7:30am in the dentistry room.
D. Dermatology
Students will meet at 8:00 A.M. for rounds in the dermatology rounds room (B105A). Cases are received
Monday, Tuesday, Thursday and Friday in the morning and early afternoon. Wednesday is reserved for
diagnostics and Dermatopathology rounds. Afternoon rounds consist of a discussion of all cases seen that
day. Kodachromes of a variety of dermatology cases may be reviewed by the students following afternoon
rounds. These will be discussed in detail with the clinician.
E. Equine Ambulatory
The overall objective of the Equine Ambulatory Section is to create clinical preparedness in the student with
indoctrination into owner relationship and economics involved. The goal is to aid in the transition from
academic to practice environment. Specific objectives include:

To understand and implement diagnostic and therapeutic techniques and methods related to the respiratory
system, the digestive system, the musculoskeletal system and the urogenital system with emphasis on
reproduction and infertility.

To understand and implement chemical and mechanical restraint.

To understand the basic concepts of emergency care and wound treatment.

To understand the relationship between the client and veterinarian as it relates to communication, public
relations and economics.
Tasks assigned to the student while on duty:

Meet in the Large Animal reception area Monday through Friday at 8:00 am for instruction and daily
assignment.

Vehicles should be serviced and ready to go by 8:00 am (whenever possible, service and restock the
afternoon before).

Familiarize self with truck and location of supplies and equipment.

Be responsible for materials taken for laboratory work.

Keep the truck clean and orderly at all times. Wash vehicle when necessary. This should be done at least
once weekly (Friday).

Records are to be completed daily and presented to clinician for signature.

All students need to carry a stethoscope and bandage scissors. (No back packs)
Round Hours:
8:30 - 9:30 am Wednesday - Large Animal Surgical rounds
8:30 - 9:30 am Friday - Large Animal Medical rounds
Dress will include clinic uniforms or coveralls as outer clothing. A professional appearance is mandatory at
all times. Appendix: VTH_Dress_Code
45
Grades will be based on: attitude, general knowledge, medical logic, clinical skills,
appearance and professional approach to a case.
F. Equine Services
Working with Horses
Horses are large animals and can cause trauma either intentionally or unintentionally. It is important that the
student recognize his/her own abilities and comfort level dealing with the patients. This is especially true
with regards to stallions and mares with foals. If the student is at all uncomfortable handling equine patients,
he/she needs to notify the faculty member, resident or technician so that they can be of assistance.
Owners are responsible for unloading and loading their animals. If the student is asked to help, they should
only do so if they are familiar with appropriate handling techniques. It is the student’s responsibility to advise
personnel (faculty, resident, technician) on the equine service that they are uneasy working around or
handling horses. At no time should a student put themselves in a dangerous or compromising situation.
Section Structure
For Large Animal Track Students
Equine Ambulatory - 2 Weeks
Equine Medicine – 2 Weeks
Equine Surgery - 6 Weeks
For General Track Students
Equine Ambulatory - 1 Week
Equine Medicine - 1 Week
Equine Surgery - 3 Weeks
Where to meet (each morning)
Equine Surgery and Equine Medicine students meet under the cover between the barn and hospital at 8:00 am
Monday morning.
Equine Ambulatory students meet in the Large Animal Reception area at 8:00 am
46
STUDENT AFTER-HOURS DUTY
FOR EQUINE AND FOOD ANIMAL SERVICEAssignment schedules are posted in the Large and Small
Animal reception areas.
Week Days
Week Ends/
Holidays
Section
Equine
Food Animal
Equine Amb.
Dairy Field
Service
Time
5-10 pm
5-10 pm
5 pm - 8 am
5 pm - 8 am
No. of
Students
1
1
1
1
Section
Equine
Food Animal
Equine
Food Animal
Equine Amb.
Equine Amb.
Time
8 am - 3 pm
8 am - 3 pm
3 pm - 10 pm
3 pm – 10 pm
8 am - 3 pm
3 pm - 8 am
No. of
Students
1
1
1
1
1
1
Student
Location
In Barn
In Barn
On Call
On Call
Student
Location
In Barn
In Barn
In Barn
In Barn
On Call
On Call
For the number of students assigned to after hours duty (barn duty) will vary depending on season and case
load. At times when one student is not sufficient to cover the case load in The Equine Hospital, barn back up
student will be called in.
G. FOOD ANIMAL INTRODUCTION
The food animal medicine and field services provide comprehensive medical and herd health services for
several contract dairy herds and other local livestock producers including cow-calf, feedlot, sheep, goat, and
camelid operations. Your participation in these services will expose you to many diverse activities including:

Clinical Case Management

Reproductive Evaluation

Herd Record Analysis

Herd Mastitis Management Programs

Herd Disease Investigation

Field Research
47
The goal of these rotations is to provide students with a learning environment that is similar to a multi-faceted
private food animal practice scenario. This will create a dynamic experience that will provide both core
learning opportunities as well as flexibility for individuals to pursue specific interests.
1. FOOD ANIMAL MEDICINE (FAM): Students in the Food Animal Medicine (FAM) rotation will
meet in the food animal classroom or records room at 8:00 am on the first day of the rotation.
We will make general announcements, review any special service activities for the week, and assign
students to these special service activities. All students will participate in a general orientation at this
time.
2. FOOD ANIMAL FIELD SERVICE (FAF): Students in the Food Animal Field (FAF) service
rotation will meet at the large animal reception desk on the morning of the first day of the
rotation. If the rotation starts on Monday, meet at the LA Reception Desk at 7:30 AM. If the first
day of the rotation is not Monday, call (491-0375 of, 217-6919 cell) or email Dr. Dinsmore (491-0375
office, 217-6919 cell Page.Dinsmore@colostate.edu) the week prior to find out when and where to
meet. Feel free to contact Dr. Dinsmore with any questions. The schedule for the remaining rotation
will be discussed during orientation. The service will often leave the hospital prior to 8:00 am.
3. SPECIAL SERVICE ACTIVITIES: Periodically, we have the opportunity to include students on
unique service activities in the field. These opportunities will be announced and interested students
will be selected to participate in these activities.
GENERAL INFORMATION
1. Rotation Assignments: Permission to change a rotation assignment must be obtained from the faculty
clinician on the rotation and then cleared with the Clinical Sciences Department through the Senior
Practicum Administrative Assistant (Debbie Liptak). A change of rotation approval slip must be
signed and returned to the department office prior to the rotation.
2. Attendance: As per College policy, students may be excused from clinical rotations for State Board
Examination, job interviews, or other activities deemed appropriate by the rotation faculty member
provided that they have permission from the rotation faculty clinician. Students must present an
Absent From Clinical Assignment Form to the faculty clinician when requesting an absence.
Students are allowed ONE DAY of excused absence per rotation. Students missing more than one
day of a rotation will be required to make up those days on the rotation. Individuals missing more
than THREE days during their rotation will be required to make up the entire rotation to fulfill
DVM requirements. After hour duty obligations are the responsibility of the person originally
assigned to the clinical rotation and it is their responsibility to make arrangements for another student
to take their place. Students missing more than ONE day of the rotation will receive an incomplete (I)
grade for the rotation. Students with unexcused absences and students who miss after hour duty
assignments will receive an Unsatisfactory (U) grade for the rotation and will be required to repeat the
rotation. Within one week of returning to campus, students are required to make arrangements with
the faculty member(s) in charge of the rotation to make up the missed assignment(s). Individuals
missing more than 5 days total during their senior year will be required to make up the missed
clinical assignments on a day for day basis to fulfill DVM requirements.
3. Clothing & Equipment:
48
A. Attire must be professionally appropriate (see VTH Dress Code) and CLEAN EACH DAY.
Coveralls worn over pants and a collared shirt are recommended. All students must have clean
surgical scrubs available. Dirty coveralls should not be worn home. If your clothing becomes
soiled (feces/blood) use good judgment about where you subsequently wear it. Students with
inappropriate attire will be dismissed from the service until they return with appropriate
clothing. Time away will be recorded as an unexcused absence and reported to the department
office.
B. All students must have at least TWO PAIR OF CLEAN COVERALLS each day of the
rotation.
C. Protective RUBBER OVER BOOTS (not boots that fit over stocking feet) are required. We
recommend wearing sturdy leather boots under your over boots. Serious injury can occur if a
large animal steps on your foot and you are wearing only a rubber boot over tennis shoes.
Students with inappropriate boots will be dismissed from the service until they return with
proper boots.
D. A stethoscope, hemostat, and penlight are required for all food animal services. Thermometers
are provided on the rotations. Disposable thermometers are used in the Food Animal Hospital
and are available in the records room and treatment areas. Digital thermometers are available
for animals with high fevers. DO NOT LEAVE THERMOMETERS IN THE RECORDS
ROOM as they lead to contamination of this area, the records, and the medications.
4. Emergency Duty Assignments: The emergency duty rosters are posted on the bulletin board outside
the men's locker room on the second floor, in the Food Animal Hospital Records/Repro Lab, and at the
Large Animal Reception Desk.
A. Food Animal Hospital After Hours Duty: After hour hospital duty runs from 5:00 pm to
10:00 pm on weekdays. All students will share these responsibilities. After hour duty on
weekends and holidays is divided into two shifts; 8:00 am to 3:00 pm and 3:00 pm to 10:00
pm. Students should plan to overlap these duties by 10 to 15 minutes to ensure an orderly
transfer of case responsibilities. Your regular service responsibilities must be completed
before your duty assignment begins. If you are in the field and are delayed for your after
hours duty, have the field service clinician call the hospital to inform the hospital
clinician of your estimated time of return to the hospital.
Responsibilities on After Hour Duty: The large animal emergency clinician, food animal
resident or intern on duty, and the on-duty hospital technician are in charge during after hour
service including weekends and holidays. The emergency clinician, resident, or intern may
request that students remain beyond regularly scheduled hours if necessary. Duty students are
to remain on the VTH premises at all times during their duty assignment. When not with a
patient, you should remain in the Food Animal Hospital Records/Repro Lab so that you can
answer the phone located there (297-1236, 297-4023). Designated food animal technician
assistance is available on weekdays from 5:30 to 9:00 pm and on weekends and holidays from
8:00 am to 9:00 pm. Do not hesitate to request the assistance of the (equine) hospital
technician if a designated food animal technician is not available. Responsibilities on all
after hour duty assignments include the following:
2. Making hourly rounds to observe every patient in the Food Animal Hospital. This includes
animals in the regular hospital, calf isolation, food animal isolation, or holding pens on the east
49
side. The status of any animal showing a significant change or any animal whose condition is
steadily deteriorating should be brought to the attention of the on-duty technician, intern, or
clinician on the case. In the event that these individuals cannot be reached, the emergency
resident or intern on duty should be contacted and the notification recorded in the progress
notes.
3. Intravenous fluids must be monitored closely and the remaining volume recorded hourly on the
stall sheets to make sure the prescribed rate is being administered. Watch fluids closely when
nearly gone so that they do not run out unattended and result in a clotted catheter. If additional
fluids are not immediately available, flush the IV line with heparinized saline.
4. Provide the treatment, monitoring, and care of all patients in the food animal hospital in
conjunction with the after hour technician. This includes administration of all
treatment/monitoring orders (stall sheets) for the designated duty period and assisting with any
ongoing procedures or surgeries.
5. Assist the after hour food animal technician with milking any lactating cows.
6. Assist the LAEM service in receiving and working up emergency cases. Normally the LAEM
student will take primary responsibility for any after hour cases that are admitted until they are
transferred to the FAM service the following morning.
7. Complete all of the paperwork associated with any case admitted where the emergency duty
intern or resident has assigned you primary responsibility. This includes the history and
physical exam sheet, the stall sheet for treatments and monitoring, an initial SOAP with
assessment and plan, and a surgery report if you were involved in a surgery.
8. If you receive an emergency case, you are responsible for administering morning treatments
and providing a morning assessment of the patient for the clinician on duty the following
morning. If you are unavailable to do this for any reason (including field service
obligations), find another food animal service or LAEM student who will assume
management of the case. Failure to appropriately transfer responsibility for the case you
received will not be tolerated and is grounds for an unsatisfactory grade for your current
rotation.
9. Maintain security of the barn. Please keep all doors to the outside closed when not in use.
Unidentified individuals should be approached courteously and asked if they need assistance.
Questions regarding hospital patients should be referred to the resident, intern, or clinician on
the case. "Tourists" should be requested to make arrangements with the Hospital Director's
Office for a guided tour during regular hours.
10. Failure to complete any of the above responsibilities could result in an unsatisfactory grade for
your current rotation.
B. Emergency Pager Duty: All students will share emergency pager duty. The student on
emergency pager duty is on call from 4:30 pm to 8:00 am Monday through Friday and from
8:00 am to the next 8:00 am on Saturday, Sunday, and holidays. Students on duty should
remain near a phone and be able to arrive at the hospital within 15 minutes of being
called. Student cell phones may be used. If you do not have a cell phone, you may obtain a
temporary pager from the large animal reception desk. It is the responsibility of the student to
ensure that the pager is working correctly and that the pager number you will be using is left
with the reception desk. Malfunction of a pager will not be accepted as an excuse for missing
a call.
50
Responsibilities of Emergency Pager Duty: The student on emergency pager duty provides
backup assistance for the Food Animal Hospital and emergency assistance for the Field
Service. The student may be called in to help with admission of emergency cases to the food
animal hospital or provide additional treatment or surgical assistance when needed. Also, they
will be called to assist with any Field Service emergencies. Failure to respond to a call or page
will result in an unsatisfactory grade for the rotation.
C. Changing After Hour and Emergency Assignments: Occasional conflicts or illnesses may
occur which will require a change in assignment. All changes in duty assignments must be
recorded on the emergency schedule in the large animal reception office and in the Food
Animal Hospital Records Room. FAILURE TO REPORT FOR YOUR DUTY WILL
NOT BE TOLERATED AND WILL RESULT IN AN UNSATISFACTORY GRADE. It
is the student's responsibility to secure a replacement for any missed clinical or emergency
duty assignments.
5. Grading: Written rotation evaluations will be completed on the computer assessment program for
your rotation. Clinicians, residents, interns, and technicians may all contribute to these evaluations.
Students are encouraged to read the FAM Objectives and Assessment handout for details concerning
clinical proficiency expectations for the FAM rotation. Several conditions constitute either an
unsatisfactory or an incomplete grade.
Pass:
o
Adequately performed the duties and responsibilities of the rotation.
Incomplete:
o
Approved absence of more that ONE day during any rotation.
o
Failure to complete the required rotation objectives.
o
A student with an incomplete grade for the rotation will be required to complete the deficiency
or repeat the entire rotation at some later date.
Unsatisfactory:
o
Unexcused absence from regular or after hour duty.
o
Incompetence or failure to properly manage assigned clinical cases.
o
Repeated disregard for hospital policies and blatant disregard for professional conduct.
o
Unsatisfactory completion of the required learning objectives.
o
Rotations receiving an Unsatisfactory grade must be repeated at a later date.
o
A student receiving two Unsatisfactory grades in two different hospital rotations will be
dismissed from the PVM program.
6. Biosecurity:
A. All biosecurity protocols must be followed both in the hospital and in the field. Please refer to
the Food Animal Biosecurity SOP if you have questions.
B. Isolation: Food animal students should review the isolation and disinfection procedures
outlined for the Food Animal Hospital and in the Biosecurity SOP. You may be receiving
51
animals with infectious disease and you should be aware of the proper procedures to minimize
risk of exposure to yourself and other animals.
7. Always clean up after yourself and replace equipment to its proper place.
8. Food or drink is permitted in the Food Animal Classroom. No food or drink is allowed the hospital
area except in the technician office with the consent of the technicians. You must clean up after
yourself and put all trash in a garbage can (not beside it, i.e. pizza boxes).
FOOD ANIMAL MEDICINE AND SURGERY SERVICE (FAM)
1. Description: The Food Animal Hospital service encompasses a wide range of case types including
medicine, surgery, and reproduction. The service provides primary patient care for all food animals
and camelids that are admitted to the hospital. In addition, consultation is periodically requested from
other VTH specialty services such as equine surgery, neurology, ophthalmology, cardiology,
dermatology, etc. Consultation with specialists is essential for optimal patient evaluation and care in
some situations. However, this consultation should not replace diligent patient examination and
formulation of a problem list by individuals having primary patient care. In all instances, you will
remain as the student primarily responsible for the evaluation, care, treatment, and records of your
assigned patients.
2. Goals:
A. Patient Care: Provide complete evaluation, assessment, diagnostics, and treatment of
livestock patients admitted to the hospital. The economic aspects of production livestock must
always be considered. Therefore, there may be instances where a diagnosis is more important
than the treatment of an individual animal in order to prevent or limit disease in a herd. When
this is not the case, patient care is given top priority in conjunction with economic
considerations.
B. Teaching and Information Gathering: A great deal can be learned from each case. For
optimal patient care, students must be willing to read, consult, and ask questions regarding any
procedure or condition they do not feel comfortable with. Some laboratory data or samples
may be requested for teaching or to gather data for clinical research. While collection of some
data may not reflect the limitations of real world food animal medicine, the purpose is to
provide you with information and identify likely changes to improve your knowledge
regarding disease, diagnosis, monitoring, and pathophysiology. However, since funds are
limited, ask first before collecting and submitting samples.
C. Specific Rotation Goals:
1. Develop a thorough and systematic approach to obtaining a complete history and
physical examination. Please review your notes from the Junior Practicum Food
Animal Physical Examination Laboratory.
2. Systematically evaluate each patient using the Problem-Oriented Medical approach.
Learn to evaluate the patient's signalment, history, physical examination, and laboratory
data (CBC, chemistry profile, rumen fluid analysis, cytology, etc.) in order to formulate
a problem list, a ranked differential diagnosis list, diagnostic plan, treatment plan, and a
prognosis.
52
3. Utilize a problem oriented medical record (SOAP) for recording the medical
management of the patient. Medical records must be complete, accurate, and legible.
Understand the legal requirements of a medical record
4. Develop proper handling and restraint techniques for food animal patients including
cattle, sheep, goats, camelids, and swine.
5. Learn how to feed and care for the above species considering age, production goals,
species, and medical condition.
6. Utilize multiple sources of information (texts, journals, computer programs, etc.) to
help guide the care and treatment of each case.
7. Become familiar with commonly used drugs in food animal species including proper
dosages and withdrawal periods for meat and milk.
8. Understand the market value of calves, cull cows, slaughter cows, replacement animals,
and the cost of diagnostics and treatment so that economic considerations regarding
treatment can be made.
Maximum benefit from participation in the FAM Rotation requires initiative on your part.
Decide what YOU think, COMMIT yourself to a plan and submit your ideas to critical review
by the interns, residents, and faculty clinicians. Strive to develop a complete problem list,
differential diagnosis list, and preliminary plan as you present your case to the resident, intern,
or clinician. There is usually more than one way to approach a given problem and the
clinicians are open to your approach if it is logical and you can explain your reasoning.
Ideally, the clinician should steer your management of each case rather than dictate your
participation. Clinicians also learn much from the diverse student backgrounds. However, if
you are a passive participant, the clinician will soon take charge and you will become a
"gofer". Also, realize that during extremely busy times, the clinician will become a director in
order to accomplish the work in a timely fashion. You can still learn much by participation in
these situations.
3. Daily Schedule: The majority of patients admitted to the Food Animal Hospital require urgent care
and there are fewer "elective" cases that are scheduled at the beginning of any given day. Therefore, it
can be difficult to maintain an orderly schedule. Our planned daily schedule is:
Day
Time
Activity
Monday
8:00 am
Orientation/Rounds
Tuesday
8:30 am
Rounds
Wednesday 8:00 am
Rounds
Thursday
8:30 am
Rounds
Friday
8:00 am
Rounds
8:30 am
Grand Rounds
1:10 pm
Necropsy Rounds
Saturday
8:00 am
Rounds
Sunday
8:00 am
Rounds
53
Theoretically, we receive cases in the morning and work up cases, do surgery, etc. in the afternoon. In reality,
cases arrive at all hours. Lunch is taken when (and if) we get a chance and we will make every effort to
provide you with a 30 minute lunch break. Necropsy rounds at 1:10 pm on Fridays are attended when time
permits. The day ends when the work is done, which is quite frequently after 5:00 pm. Short evening rounds
are held to assess the day's progress, assess new data, review monitoring plans, etc. Due to scheduling, the
most extensive rounds discussions will be held on Monday, Tuesday, and Thursday. Unless other
arrangements are made, rounds will be held at 8:00 am on Saturday and Sunday. All students are expected to
attend Saturday rounds and help with morning treatments. Students with active cases are expected to attend
Sunday rounds. On weekends and holidays, students are responsible for morning assessment and treatments,
submitting additional laboratory tests, writing SOAPs, etc.
4. Receiving Patients:
A. Generally, you will meet the client as they unload their animal at the Food Animal Hospital. Most
adult cattle are unloaded on the east side. Camelids, goats, sheep, and pigs are generally unloaded
at the north door. Calves with infectious diseases (scours, respiratory disease) are unloaded on the
south side at the door entering calf isolation.
B. History: A complete and thorough history must be obtained for every animal and completed
electronically in VetPoint. Include diet, vaccination, deworming, production, and other
management factors, in addition to the current problem. Unfortunately, the individual bringing
the animal may not have complete information. Always check with the intern or clinician on duty
in case they have received more detailed information from the client or referring veterinarian.
C. Most adult cattle are unloaded via the chutes on the east side of the hospital. Small ruminants and
camelids are generally received at the North door. Most examinations occur in the animal‟s stall
or in the treatment chute. Down animals should be unloaded as close to the down cow stalls as
possible (via the north doors). Some animals (pigs, etc.) are occasionally examined in the trailer.
D. Physical Examination: Every animal admitted will have a complete physical examination,
preferably at the time of admission. Occasionally, when we are extremely busy, the immediate
problem will be attended to and the complete physical examination accomplished later. We will
perform physicals in two ways:
1. The student performs a physical examination first and the resident, intern, or clinician
double checks the findings later.
2. The student and resident, intern, or clinician perform the physical examination
together.
In either case, the student is responsible for recording the final complete findings as verified
by the resident, intern, or clinician. The physical examination must be completed
electronically in VetPoint.
E. Keep the record paperwork in order, and make sure that the intern or clinician has discussed the
fee estimate with the client.
F. If the patient remains for hospitalization, place all loose paperwork together in one of the brown
ring folders in the records room before the end of the day.
G. Prepare a stall for the animal if it is to stay in the hospital. Spread some straw in the stall and set
up a footbath.
54
H. All inpatients must have a stall card on the stall at all times, with the senior clinician listed as
clinician in charge.
I. Responsibility: It is the direct responsibility of the student assigned to a case to ensure that it is
managed as per resident/intern/clinician instructions. Students should ask for assistance and
guidance in obtaining samples for submission in a timely manner and for carrying out various
treatments.
5. Records:
A. Master Problem List: The master problem list should be completed and maintained by the
student assigned to the case.
B. History and Physical Examination: Complete electronically in VetPoint
C. Progress Notes (SOAPs):
1. We will use the Problem Oriented Medical Records system ("SOAP" system) for
maintaining patient records. You should review INSTRUCTIONS on how to write a
proper SOAP before you begin the rotation. Active problems must be identified on
every day that the animal is hospitalized.
2. A complete SOAP must be written for each day the animal is at the VTH. THIS
INCLUDES THE DAY OF ADMISSION AND THE DAY OF DISMISSAL.
D. Daily Stall Sheets:
1. Stall sheets will be completed by the student, resident, intern, or clinician assigned to
the case. Each daily stall sheet includes all daily treatments and monitoring of the
patient for the 24 hour period starting from 7 pm of the current day to 7 pm the
following day. Each stall sheet must be COMPLETED FULLY including the
complete case identification, stall number, and date on each side of the sheet.
2. Directions on stall sheets MUST BE EXPLICIT. All medications must have
complete dosages listed including the amount to be administered, route, site,
frequency, fluid rate, etc. All after hour medications must be pulled up as single doses,
labeled, and must be available for after hour treatments in either the patient's box or in
the refrigerator.
3. All treatments and monitoring of the patients will be listed and highlighted on the stall
sheet. When tasks are completed, the appropriate information must be recorded on the
stall sheet or in the progress notes of the record and initialed.
4. After hour treatment and monitoring instructions can be posted near the dry erase
board in the Livestock Medications Room.
5. If you are on duty and a stall sheet is incomplete, illegible, unclear, or if you have
difficulty with the procedure, DO NOT HESITATE TO CALL THE
RESPONSIBLE STUDENT FOR CLARIFICATION. If the student cannot be
reached, call the intern, resident, or clinician on the service. If these individuals cannot
be reached, call the intern or resident on emergency duty.
6. If you have complicated procedures to perform after hours, return to the hospital and
ask the student on duty to assist you.
7. Daily treatments will usually be given in the morning before rounds by the student
assigned to the case. The student on Livestock Hospital duty will perform the evening
treatments unless they are overly intensive and require additional assistance from the
student assigned to the case. Because of the difficulty in handling some large animals,
55
some BID treatments will be compressed in order to administer both treatments during
regular hours. The morning treatment should be given before rounds and the evening
treatment can be given between 4:00 pm and 6:00 pm.
E. All SOAPs and Stall Sheets must be completed before you leave for the day, preferably before
5:00 pm.
F. Records are to be kept up to date, in order, and stored in the proper slot in the FAM
Records/Repro Lab at all times! Do not remove patient records from the records room.
6. Dismissals:
A. When an animal is scheduled to go home, have a technician, resident, intern, or clinician fill out
the charge sheet and then take that sheet to the business office prior to the client's arrival and
dismissal of the animal. All clients (except contract dairy clients) must pay their bill at the
business office prior to loading their animal.
B. Medical Summary and Dismissal Forms: The electronic Medical Summary and Dismissal form
must be completed in VetPoint before the patient leaves. This is a very important case
management and client/veterinarian communication tool. Remember to be concise and use
appropriate terminology. The resident, intern, or clinician should check the dismissal form, print,
and sign it before the animal is released. Review the instructions with the client at dismissal. The
dismissal form is also an important legal document. A MEAT AND MILK WITHDRAWAL
STATEMENT must be included on ALL dismissal forms for ALL livestock patients. If there
are no withdrawals indicated, state so on the dismissal form. The resident, intern, or clinician will
complete the case summary form.
C. Have the dismissal form and any dispensed items ready at dismissal. All dispensed items should
have a pharmacy label and be properly packaged. Discuss the aftercare and help the client load
the animal. Always provide the resident, intern, or clinician with the opportunity to speak to
the client before they leave.
D. Once the case is completed, all electronic medical records must be printed and assembled as the
permanent record. Records should be assembled in the following order.
1. Medical Summary and Dismissal
2. History
3. Client Communication
4. Physical Examination
5. SOAPs
6. Surgery Reports
7. Diagnostic Test Results
8. Stall Sheets
9. Client Forms or any other sheets
When you have assembled the record, place the record in the To Be Completed box by the
door in the Records/Repro Lab. The intern or clinician will check the record and return it to
medical records.
7. Treatment Schedule: Students must perform morning treatments, examine their patients, and assess
their medical condition prior to morning rounds. Standard treatment schedules are as follows.
o Q24 hr - 7:00 am
56
o
o
o
Q12 hr (BID) - 7:00 am, and 7:00 pm
Q8 hr (TID) - 7:00 am, 3:00 pm, and 11:00 pm
Q6 hr (QID) - 7:00 am, 1:00 pm, 7:00 pm, and 1:00 am
If you have a particularly involved treatment or difficult animal, you should return to the hospital for
evening treatments and have the after hour duty student or technician assist you. You must assess
your duties and arrive early enough in the morning to accomplish them prior to the start of rounds.
Handling food animals requires teamwork. If you expect classmates to help you, you should be
prepared to return the favor, and allow enough time to do so.
8. Feeding:
A. Obtain an accurate feeding history from the owner. Since appetite is such an important
parameter in assessing your patient, we recommend that the student in charge of the case
perform all feedings.
B. Label the stall card with STUDENT WILL FEED and write what and how much the animal
is being fed. DO NOT WASTE FEED! If the animal has not consumed the majority of its
feed, don't add additional feed to the pile.
C. Both grass and alfalfa hay is available along with a grain mix. Haylage, silage, and total
mixed ration (TMR) are not available in the hospital. Additional feeds such as llama pellets,
pig feed, equine senior, alfalfa meal, calf manna, milk replacer, goats milk, and salt blocks are
available as needed and are stored in the feed room.
D. Feeding Recommendations:.
1. A normal healthy animal will consume at least 2% of its body weight in dry matter
per day divided into appropriate amounts to be fed at least twice daily.
2. A bale of hay weighs 60-75 points. A flake of hay weighs between 4-6 pounds.
3. Lactating Dairy Cattle
a. Will preferentially be fed alfalfa hay (provides higher calcium and protein)
rather than grass hay. Sometimes sick cattle prefer grass hay. Initially give the
animal a flake of each and see which hay they consume. Then continue with
that type of hay.
b. Should be fed additional grain at the rate of 1 pound grain for every 2-3 pounds
of milk produced. Look at the milk weight from the previous milking on the
stall sheet and calculate how much grain to feed at each feeding.
4. Beef cattle and non-lactating dairy cattle are fed primarily grass hay.
5. For poor conditioned animals, up to 30% of their dry matter intake may safely be fed
as grain. More than this and you run the risk of causing rumen acidosis. Check with
the clinician before feeding grain to an animal that is currently not being fed grain.
6. Nursing Animals
a. Will consume 10-15% of their body weight in milk per day (1 pint = 1 pound).
This is divided and fed at least BID through the day.
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b. For calves, we will feed milk replacer unless specifically ordered otherwise by
the clinician. A standard nursing bottle holds 2 quarts or about 4 pounds of
milk.
c. Goats, lambs, and crias will wither nurse the dam or be fed milk replacer,
canned goats milk, or store bought whole milk.
d. For scouring calves, the volume of milk may initially be reduced and milk
feedings are alternated with an oral electrolyte solution every 6 to 8 hours.
e. Nursing calves may also receive grain but should not be fed hay unless
specifically requested by the clinician (feeding hay to pre-ruminants delays
rumen development and decreases rate of gain). Most dairies practice early
weaning (2 months of age). The calves are kept slightly hungry to encourage
them to eat more calf starter grain. This (the scratch factor and VFAs,
especially butyric acid) causes the rumen to develop more rapidly. The rumen
will assume normal adult functions and proportions at 9-13 weeks of age. The
amount of milk fed as a percentage of body weight is gradually reduced over
the entire feeding period until the calf is weaned.
f. All neonates should receive at least 10% of their body weight in colostrum
within the first 6 to 12 hours after birth. If they refuse to nurse, tube them with
the colostrum. Make sure you record the volume consumed and the time on the
stall sheet.
7. Fresh Water must be available for ALL animals including calves in calf isolation.
Occasionally we will also provide free choice electrolyte water.
8. Salt blocks may be provided for patients when indicated.
9. Total Mixed Rations (TMR): Most of the local dairies feed total mixed rations
(TMR). These consist of chopped alfalfa, corn silage, "commodities" (bulk
concentrates like barley, brewers grains, bakery waste, wheat middlings, cottonseed
products, etc.) and mineral mixes. We are unable to feed TMR or any silage at CSU.
10. Sheep and Goats: Usually feed similar to a beef or dairy animal, depending on
lactational status (hay and grain only).
11. Camelids: Usually need grass or alfalfa hay plus water and free choice mineral
only. Llama/Alpaca pelleted feed is also available in the feed room. Equine Senior
is sometimes fed to provide additional energy but should not be used as a sole source
of food due to high fat and copper levels.
12. Pigs: There is a complete pig feed in the feed bins. This is fed free choice. Some
pigs will also eat some hay. Most pigs will eat many types of fruit including grapes,
bananas, apples, watermelon, etc. Sick pigs like flavored sport drinks and juices.
13. Lambs, Kids, Crias: Use ewe's or goat's milk at 10-15% of body weight if
available. We keep canned goat's milk in the technician office. Divide into TID or
QID feedings.
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9. Safety:
A. Work as a team.
B. Check all gates, panels, etc. when moving cattle. Walk the path you expect the animals to
take and check EVERYTHING. If you set a path and go away for any period of time,
recheck it first upon your return before you bring animals through -- someone may have
opened up a gate.
C. Make sure all outer gates are closed, latched, and chained whenever loading or unloading
bulls. Always have a technician or clinician present when loading or unloading bulls
D. DO NOT TRUST ANY BULL!
E. If you are not sure about the operation of any piece of restraint equipment, ASK FIRST!
F. If an animal escapes, get HELP and try to contain it; first in the barn, secondly on the VTH
grounds by use of the perimeter gates.
G. Animal Safety: NEVER leave an animal in a head catch or chute unattended. Tie tails only to
the animal itself and never to the chute.
10. Rounds Presentations: Both regular rounds and Grand Rounds should follow a Problem
Oriented Medical Records (POMR) format.
A. State the patient signalment each day.
B. Provide pertinent history and presenting complaint on your first rounds presentation for the
case.
C. Review physical exam findings or the morning‟s assessment findings each day.
D. Identify the active problem list and provide differential diagnoses for any problems that have
not been refined to a specific diagnosis. Rank your differential diagnoses from most likely to
least likely and explain why you rank them that way.
E. Suggest and explain a diagnostic and monitoring plan for the day.
F. Provide a treatment plan for the day including complete dosages for any medications.
G. Summarize the clinical diagnosis and current prognosis.
H. Provide any additional information that you have learned from your reading and research on
the case.
Present the case in a concise, organized format so that the other students can learn from it as well.
11. Calf Isolation Procedures:
A. All calves with a history of diarrhea will be admitted directly into calf isolation unless
otherwise specified by the clinician on duty.
B. Do not put patients of different owners side by side unless absolutely necessary.
C. Change into dedicated calf isolation coveralls and boots before entering calf isolation.
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1. Always wear gowns, boots, and gloves when working on a patient or in the stall with a
patient. When entering the isolation room, put on a pair of gloves.
2. Before entering the stall, put on one of the blue barrier gowns and another pair of
gloves.
3. When you leave the stall, take off the outer pair of gloves and the gown.
4. Finally remove the inner pair of gloves.
5. Wash your hands at the sink in calf isolation.
6. Scrub your boots in the footbath as you leave calf isolation.
7. Change back into your regular boots and coveralls.
8. Wash your hands again at the sink in the milk room area and apply disinfectant lotion.
D. Use separate thermometers and stethoscopes on individual patients in calf isolation.
E. The patient's record, except for the stall sheets, must remain outside of calf isolation and is
stored in the Food Animal Records Room.
F. Keep stock medications outside of isolation in the Medications Room until you need to take
them into isolation for the treatment.
G. Please keep contaminated items with the patient they come from. Keep the stethoscope,
gowns, boots, etc. next to that patient's stall to avoid cross contamination.
H. Keep medications, including oral electrolyte mixes in the corresponding stall boxes to the left
of the sink or if needed in the refrigerator. Label nurse bottles with clinic name, VTH Case #,
and Stall #, and put an exam glove over the nipple to store in the refrigerator after use. Please
do not leave the milk set out for over 2 hours. Mixed oral electrolytes can be kept at room
temperature.
I. Do not use the exam table as a counter top, it needs to be ready for use on the next patient.
J. What gets taken into the isolation room from the main barn, central, etc. needs to stay until the
calf goes home or it is properly cleaned and bagged to be sterilized.
K. Dispose of the blue barrier gowns in the garbage when they become soiled or unusable.
L. Do not reach into any stored equipment, syringes, needles, etc with dirty hands or gloves. Try
to get everything out prior to a procedure or take off your dirty gloves, get what is needed and
put a different pair of gloves on.
M. Record all fluids, oral electrolytes, and medications used from calf isolation on the charge
sheets on top of the incubator. Record the appropriate client's name and VTH Case # as they
need to be charged out by the Food Animal Technicians so we can continue to keep a supply
out here for your convenience.
N. Step in the foot baths whenever crossing over one. Always use a boot brush to remove any
gross debris.
O. Wash hands often and always between animals and before leaving the isolation room.
Otherwise, you contaminate the door and door knob, exposing an unsuspecting victim.
P. Think before you act! Think about your roommate, wife, husband, significant other, children,
and pets.
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12. Milking Procedures:
E. The day and night technicians will milk all lactating dairy cows. It is your responsibility to
assist them and learn from this procedure.
F. If you receive a lactating dairy cow that needs to be milked, place a "Please Milk" sign up on
the front of the stall and mark the times to be milked on the stall sheet.
G. General Milking Procedure:
1. Assemble and flush the milking machine by running several gallons of cool water
through it. Dump the bucket, rinse, and reassemble.
2. Catch the cow. Feed 1 pound of grain per 2-3 pounds of milk produced by the cow at
the previous milking. Wash the teats and base of the teats thoroughly with dilute
betadine water and paper towels. Use a separate paper towel for each teat.
3. Check milk with the strip plate and then perform a California Mastitis Test (CMT) on
all milking quarters. Record the results on the stall sheet. Wipe the teats dry with
paper towels. Use a separate paper towel for each teat.
4. Within one minute of drying the teats, apply the milking machine, with minimal air
admission (squaks). MONITOR CLOSELY! Make any adjustments necessary, milk
out completely but do not over milk. It should typically take about 5 minute of
milking time.
5. If you have a cow with a blind quarter (non-milking) or a mastitic quarter that is being
stripped out and does not need the milker attached, put a 12 cc syringe case in that
inflation so as not to lose your suction.
6. Carefully remove the machine by closing the vacuum line at the claw and letting the
claw release itself. DO NOT PULL IT OFF!
7. Open the valve to the claw again to release the tank vacuum before unplugging
the milking machine. This releases the vacuum and prevents milk from being sucked
back into the pump and damaging the pump.
8. Dip the teats in an iodine based teat dip contained in a urine cup. Allow to air dry.
Also use the latex teat shield dip for cows with diarrhea or down cows. Make sure to
use separate dip cups for each mastitic quarter (teat) if necessary and appropriately
label each cup with the Case #, Stall #, and quarter.
9. Release the cow, close the head catch, and put the tub of remaining grain in the stall
with the cow.
10. Weigh the milk on the scale by the milking room and record the milk weight on the
animal's stall sheet. Discard the milk down the drain.
11. Between cows, disinfect the machine by running several gallons of warm, dilute
betadine solution through it, dump the bucket, reassemble, and move on to the next
cow.
12. Milking Order: Clean (non-mastitic) client cows are to be milked first, followed by
the mastitic cows and/or isolation cows last. Isolation cows are best handled by hand
milking unless they are producing more than two gallons of milk.
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H. Milking Machine Cleaning:
1. Wear gloves when handling the cleaners and disinfectants.
2. Run several gallons of warm to hot dilute betadine water through the milking machine
as a rinse. Rinse the outside of the claw and bucket also. Dump down the drain.
3. Run several gallons of ALKALINE (PRITE) detergent in HOT water (mix 1 oz, 30
ml, detergent per 4 gallons water) through the milking machine. Wash the outside of
the claw and bucket. Dump down the drain.
4. Run several gallons of ACID (ORACID) rinse in COOL or TEPID water (mix 20 ml
oracid per 5 gallons water) through the milking machine. Wash the outside of the claw
and bucket. Dump down the drain.
5. Run several gallons of HOT BETADINE water through the machine. Do not rinse.
Wash the outside of the claw and bucket. Dump down the drain.
6. Return the milking machine to the records room for storage. Clean the outside of the
long hoses as needed.
7. Flush drains well and surrounding areas where disinfectants were used.
I. If there are any problems with the milking system, please contact the Livestock
Technicians, resident, intern, or clinician. If unavailable, contact building maintenance
(Jim Flowers). Milking equipment supplies are ordered by the livestock technicians.
13. Technicians:
The technicians are here to assist you, but NOT to do your work for you. They have a wealth of
knowledge and experience that you too can learn from. If you treat them with respect, they will be
your greatest allies!
14. Cleaning:
You are expected to assist the technicians with any areas or equipment the need cleaning after their
use.
FOOD ANIMAL FIELD SERVICE (FAF)
The goal of the Food Animal Field Service is to introduce and familiarize you to livestock production units
from the herd health standpoint with Dairy Production as the model. You will have the opportunity to gain
first hand experience in calf and heifer replacement management, breeding programs, mastitis management
programs, disease prevention, foot care, livestock nutrition, milking management, vaccination programs, and
any other aspect of livestock production that is of interest to you. You will also be introduced to record
keeping systems and record analysis in the evaluation of herd production and health parameters.
Most of the time will be spent on the farm. Therefore, topics will not be covered in a lecture format. Rather,
as the situation arises, we expect you to carry the ball. That is, it is up to you to be interested and ask
questions concerning each aspect of livestock production. We prefer to interact with you on a discussion
basis. YOUR INITIATIVE AND DESIRE to learn will determine how well we can both achieve our goals
during your rotation.
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1. Attire and Hygiene:
A. Clean coveralls and clean rubber over boots (boots that fit over your shoes) are REQUIRED
attire. Fitted (over the sock) boots are not recommended as they do not provide protection to
the feet from injury, they are cold in the winter, and they have deep treads which are difficult
to clean. The recommended footwear combination is heavy hard soled work boots and pull
over rubber boots. A clean pair of coveralls is required for each farm to be visited.
Students must determine how many farms will be visited each day (seldom more than 2) and
plan accordingly.
B. Students who show up in the morning with dirty boots will be asked to wash them before
getting in the truck.
C. On a given farm, hands and boots need not be washed as a matter of routine after each animal
examined. However, gross contamination of the hands with blood, pus, or manure will be
removed before handling the next case.
D. It is recommended that examination gloves be worn at all times. However, they MUST be
worn when working with any calves, normal or diseased or adult cows with infectious
diseases such as mastitis, pneumonia, or enteritis. Gloves need not be changed after each
animal, but gross contamination should be removed as necessary. Hands will be thoroughly
washed when finished working with these patients.
E. Students are expected to bring a stethoscope, hemostat, penlight, and bandage scissors.
Thermometers will be provided.
F. All instruments, including stomach tubes, mouth speculums, thermometers, and CMT paddles
will be cleaned and disinfected after each use.
G. Never return an instrument, tool, box, carryall, or ANYTHING else to the truck that is
contaminated with manure. Doing so will be grounds for failure of the rotation.
H. Eating or drinking will be allowed at the discretion of the clinician in the ambulatory vehicles
or in designated rooms on the farm.
I. At the conclusion of the visit, boots will be scrubbed, rinsed clean, and disinfected with
Vircon. If water is unavailable, dirty boots and coveralls may be placed in plastic bags and
cleaned at the VTH. Boots and coveralls will be removed and stored on the floor of the truck
or under the seat. Boots and dirty coveralls will not be stored in the vet box.
J. The floors of the truck will be washed and disinfected weekly or more frequently at the
discretion of the clinician.
2. Student Expectations:
A. Assist in restocking the veterinary truck at the end of each day.
B. Get involved with the examination, diagnosis, treatment, etc. of individual animals.
C. Thing HERD HEALTH! That is, how can we prevent problems on a herd basis?
D. When on the farm, take advantage of willing owners and ask questions. Most of our clients
are more than willing to discuss concerns and/or questions.
E. Assist in keeping individual records where appropriate.
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F. Be quality conscious. Milk is a universal nutritious product. It is up to the dairymen, with our
help, to maintain consume confidence. Become aware of the control measures in place which
help to maintain a drug free product.
Be sure to bring lunch. We seldom return to the VTH before late afternoon. Departure times during the rest
of the week will be announced during the day on Monday. If the weather cooperates, this will be an
enjoyable and worthwhile learning experience for everyone.
FOOD ANIMAL DRUG USE
1. Labeled Drug Use: Use of a drug which has been specifically approved by the Food and Drug
Association and labeled for use in food producing animals. This means that a withdrawal time for
meat, milk, and/or eggs has been established for the drug. Using an approved drug in strict accordance
with the label directions for species, indications, dose, duration, and route of administration is
considered labeled drug use..
Example: Albon (sulfadimethoxine), 40% injectable solution, 25 mg/lb IV q24 hours for 3 days to a lactating
cow with footrot is an approved use of an approved drug. The withdrawal times for this use are 60 hours for
milk and 5 days for slaughter.
2. Extra Label Drug Use (ELDU): Any use of a legal drug in a manner which is not approved by the
FDA and expressly indicated on the label. This includes both drugs approved for use in the species as
well as drugs that are not approved. It is illegal for a producer to initiate extra label drug use on their
own. Withdrawal times have not been established by the FDA for extra label use of drugs and thus the
veterinarian takes full responsibility of drug residues when recommending a drug for extra label use.
Example: Procaine Penicillin G, 300,000 IU/ml, 22,000 IU/kg, IM, q12 hours for 5 days to a beef cow with
footrot is an extra label use. While this is a drug that is approved for cattle, the dosage here is greater than the
labeled dose. While you have the right to prescribe this drug to be used at this dosage, you must take
responsibility for establishing a safe withdrawal period. The normal withdrawal period for procaine penicillin
G is 72 hours milk and 10 days for meat. Used at this higher dosage, we recommend extending the
withdrawal periods to a minimum of 120 hours for milk and 30 days for meat.
Extra label drug use requires a veterinarian's prescription and a valid Veterinarian/Client/Patient
Relationship (VCPR). The American Veterinary Medical Association, the American Association of Bovine
Practitioners, and the Food and Drug Administration have set criteria for extra label drug use. The criteria are
formulated as the FDA's Compliance Policy Guide and is part of the Animal Medicinal Drug Use
Clarification Act of 1994 (AMDUCA)







ELDU is permitted only by or under the supervision of a veterinarian.
ELDU is allowed only for FDA approved animal and human drugs.
A valid Veterinarian/Client/Patient Relationship is a prerequisite for all ELDU
ELDU for therapeutic purposes only (animal's health is suffering or threatened).
ELDU is not permitted for drugs used for production purposes.
Rules apply to dosage form drugs and drugs administered in water.
ELDU in feed is prohibited.
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

ELDU is not permitted if it results in a violative food residue, or any residue which may present a risk
to public health.
The FDA prohibits ELDU of specific drugs (see below)
Additional information regarding AMDUCA can be obtained form the AVMA site or the FDA site.
3. Veterinarian/Client/Patient Relationship (VCPR):
o
The veterinarian has assumed the responsibility for making medical judgments regarding the
health of the animal(s) and the need for medical treatment, and the client has agreed to follow
the veterinarian's instructions
o
The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or
preliminary diagnosis of the medical condition of the animals(s). This means that the
veterinarian has recently and is personally acquainted with the keeping and care of the
animal(s) by virtue of an examination of the animal(s), and/or by medically appropriate and
timely visits to the premises where the animal(s) are kept.
o
The practicing veterinarian is readily available for follow-up evaluation in the case of adverse
reaction or failure of the regimen of therapy.
4. Prohibited Drugs:
o
Chloramphenicol
o
Clenbuterol
o
Diethylstilbestrol (DES)
o
Dimetridazole
o
Ipronidazole
o
Other Nitroimidozoles (i.e. Metronidizole)
o
Furazolidone
o
Sulfanamide drugs in lactating dairy cows (except approved use of sulfadimethoxine (Albon),
sufabromomethazine, and sulfaethoxypyridazine)
o
Extra Label Use of Fluoroquinolones (Note: enrofloxacine (Baytril) is only approved for the
treatment of respiratory disease in beef animals and dairy animals <20months of age at the
labeled dosage and route. Danofloxacin (A180) is only approved for the treatment of
respiratory disease in beef animals.)
o
Glycopeptides (i.e. vancomycin)
o
Phenylbutazone in dairy cattle
5. Over the Counter (OTC) Drugs: Any drug which can be sold directly to producers without a
prescription. The FDA determines whether a drug can be marketed OTC primarily on the basis of
safety to the use, route of administration, and the potential for severe side effects or toxicity.
6. Prescription Legend Drugs (Rx): A drug which may be dispensed to producers ONLY with a
prescription because of safety, route of administration, or harmful side effects. Clients cannot legally
65
purchase these drugs without a prescription. Firms caught selling these products to producers without
a prescription may be penalized.
a. May be used in an Extra Label fashion if the criteria of AMDUCA are met.
b. Always carry the label message, "Federal (USA) law restricts this drug to use by or on the
order of a licensed veterinarian". Other labels like, "sold only to graduate veterinarians"
does not imply prescription legend. This statement is often placed on drugs by firms who
choose to sell their products only through a veterinarian.
c. Prescription drugs can be left on farms for use by producers or herdsmen ONLY if the
prescribing veterinarian attaches a label with his/her name and address, and specific directions
for use.
d. To avoid misuse of antibiotics, the FDA amended the Pasteurized Milk Ordinance to require
that all drugs on dairy farms be properly labeled and stored on shelves and/or cabinets marked
"lactating" or "non-lactating".
7. Withdrawal Periods:
a. All food animal clients must be informed of the meat and milk withdrawal periods for any
animal that received drugs.
b. On FAM this is done in writing on the Medical Summary and Dismissal Form and a
statement must be included on all dismissal forms even if no withdrawal period is required.
The clinician should verify the withdrawal periods.
c. THE WITHDRAWAL PERIOD ON THE BOTTLE IS INVALID IF SPECIES,
DOSAGE, ROUTE OF ADMINISTRATION, OR DURATION OF THERAPY ARE
NOT IN ACCORDANCE WITH THE LABEL INSTRUCTIONS.
d. Additional drug use and withdrawal information can be obtained from the Food Animal
Residue Avoidance Database (FARAD).
H. Large Animal Emergency Medicine (E.M.) Duty
Is a separate rotation from the regular Food Animal and Equine services rotations. Students on this service
are responsible for night time care of large animal patients.
Orientation for this service: Approximately 1 week before the assignment begins an orientation handout will
be in your mailbox. You must be thoroughly familiar with this information before the rotation begins.
LAEM Student Duty Roster
Sunday Evening (First Night)

On-call student available for emergencies 4:30 pm – 8:00 am**

Orientation in Equine Barn (all students) 9:00 pm
Monday – Friday

On-call student available for emergencies 4:30 pm – 8:00 am

Rounds (meet in Medicine Rounds Room) – ALL STUDENTS 7:00 am*

LA Hospital I and II in barn 10:00 pm – 8:00 am
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Weekend



No rounds
On-call student (available for emergencies) 4:30 pm – 8:00 am
LA Hospital I and II in barn 10:00 pm – 8:00 am
*Rounds will be held at 7:00 am M-F unless otherwise notified by clinician on duty
**On-call student for first Sunday must pick up LAEM pager (498) from Large Animal reception (black
cabinet) before 4:30 pm
LA Hospital 1 and 11 students as well as the on-call student are required to begin duty in the barn at 10:00pm.
If there is sufficient help, the on-call students may go home. In general, both the LA hospitals 1 and 11 will
be required to stay in the barn from 10:00 pm to 8:00 am. The LA hospital 1 student will stay in the equine
barn and the LA hospital 11 will stay in the food animal barn. The on-call student will carry the pager,
receive, SOAP, ready treatments, and go to surgery with any patient after hours also be responsible for the
post-op management until 8:00 am on all emergency cases. On-call students will do 7:00 am treatments on
any emergency cases taken in during their shift. Case responsibility will be transferred to a medicine, surgery,
or critical care service the following morning including weekends. We will still round on these cases
allowing students to see the postoperative progress of their cases.
Equipment and Clothing
Students on the rotation are required to have clean coveralls, a smock, name tag, stethoscope, hemostat and
scissors. Students are reminded that professional appearance always important, but especially on the days
when the group is receiving and will be interacting with clients.
Grading
Grading for the equine section is by pass/fail. A student must pass each week of the block and will be notified
as soon as possible of their unsatisfactory performance. Failure to pass a rotation will result in the temporary
grade of U. The student will be given the opportunity to make up this grade after the end of the block in
which an unsatisfactory grade was obtained. The requirements and procedure for the student to make up the
U grade will be determined by the instructors involved in giving the unsatisfactory grade. Failure to satisfy
the requirements will convert the U to an F.

Failure of a student to report for night/weekend duty or to be available while on duty will result in an F
grade.

Clinicians will evaluate the student's performances based upon record keeping, patient care, clinical
skills, problem solving ability, and knowledge.

Students whose performances are inadequate will be notified when these deficiencies are apparent.
Any student who has questions regarding his clinical performance of requirements should consult an
appropriate clinician without delay.
Cleanliness Around the VTH
Please keep the records room neat and tidy.
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Don‟t forget to clean up the outpatient area, especially horse feces. If a horse defecates while out of its stall
please remove the feces. If a horse also defecates while walking outside please pick up the feces and spray
with disinfectant.
Don't walk horses in the front of the hospital.
No eating in the barn or in front of clients.
Clinical Cases
The clinical case provides the necessary opportunity for the student to apply the basic knowledge and skills
attained in previous years towards the diagnosis and treatment of a case. It will also give the student practice
in dealing with a client.
The student should be able to:

take a complete history

perform a physical examination of the patient

define the patient's problems

select appropriate diagnostic tests and procedures

based on the above, arrive at a diagnosis

give a prognosis

decide on treatment and/or management for patient
Provided with a Problem Oriented Veterinary Record, the student should be able to record his or her approach
to defining the patient's problem, and subsequently treating and following the patient's daily progress. The
record will be used to evaluate the student's approach to the patient's problems. All record entries should be
signed by the student and done on a daily basis.
Computer case simulations may be used to supplement cases seen in the clinic.
Feeding Protocol
Determine the diet to which the animal was accustomed before feeding if at all possible.
Try not to drastically change diets (i.e., feeding alfalfa to a horse only accustomed to grass hay or pasture).
Discuss dietary management with the clinician in charge of the case.
Check the stall to make sure a salt block (or 1/2 of a salt block) is present and the water is clean and working.
Be sure the stall card has type of hay to feed recorded on it.
Feeding Schedule
All horses in the barn are fed at 7 to 8 am and 3 to 4 pm every day (yes, weekends and holidays too). Barn
staff feed only the horses and only provide hay.
Any grain or other supplements must be fed by the student - barn staff does NOT feed grain.
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Do NOT feed hay to horses, even on weekends unless you put up a sign "student will feed" in which case, you
are solely responsible for its feeding.
Unless specified differently on the card, all horses will be fed 20-30 lbs. grass/alfalfa hay mix per day.
Barn crew does not fill water, refresh water or dump water. Water of all equine patients is the responsibility
of the student on the case.
Rounds
Large Animal Rounds (equine and food animal) are held from 8:30 am – 9:30 am Fridays.
Radiographs must be signed out the night before or at an arranged time before 8:30 am on those cases
requiring them for rounds discussion. Please return them to radiology as soon as rounds are over.
Other Items of Importance
Clients should take all tack with them when they go.
Students are responsible for having their cases “SOAPED” (eg. Records typed into computer and written in
records then signed) daily. Routine treatments are to be done prior to morning rounds each day. It is
important that everyone be punctual for rounds.
Weekend rounds will be conducted between 8:00 am and 9:00 am by the respective clinicians.
Seniors are to report to rounds unless previously arranged with the doctor in charge. Students will not be
excused from weekend rounds without proper provision for patient care. In such cases, it will be the student's
responsibility to arrange for someone to care for their cases and to see that such personnel are adequately
briefed on all cases. The clinician in charge must approve any such change in scheduling.
Protocol for Equine Surgical Patients
Surgery/Anesthesia requests for patients admitted for surgery should be submitted prior to 3:00 pm the day
before. Special forms are provided for this. These are kept on the rack on the desk beside the autoclave in the
equine surgery suite and should be submitted on the counter top at the nurses‟ station. This is mandatory to
assure proper handling of the case by nursing staff and anesthesia. Exceptions are obviously emergencies. As
soon as an impending emergency arrives, notify the large animal surgical nurse. Even if it is doubtful about
surgery, fill out the proper forms to allow anesthesia to plan their day and assign cases.
On the physical exam, pay special attention to the cardiac, pulmonary, and urinary systems. Be sure to get
information regarding insurance status, vaccinations (tetanus), feeding, deworming, and Coggins test. Be sure
tetanus prophylaxis is current.
All patients to be anesthetized will have a minimum data base of a PCV and TP. Horses between 4-10 years
of age will have, at a minimum, a CBC and pre-surgery panel. Horses greater than 10 years of age will have a
CBC and full panel. Results are to be interpreted. Contact anesthesia students to verify that a pre-anesthetic
evaluation will be done.
N.P.O. - The night before surgery the horse will be muzzled at a time agreed to by the surgeon. Make sure the
muzzle is firmly attached to the halter (use some white tape or string if needed) to ensure the horse doesn't
69
dislodge the muzzle and begin eating. Students may ask the night duty students to muzzle the horse but it is
the ultimate responsibility of the student on the case to see that the horse gets muzzled. Stalls are cleaned 510 pm week nights. A „No Feeding‟ sign must be put on the door the evening before cleaning is desired. If
there is no sign on the door, animals will be fed.
Horses' shoes should be pulled prior to anesthesia. If they cannot be pulled, check with the surgeon; the
hooves will need to be wrapped instead. This is to protect the horse and the recovery stall padding.
The morning of surgery, all patients are to be groomed thoroughly. Extremely dirty horses may need to be
washed the day before. The horse is then taken to the surgery preparation room (H-113). In this room, the
mouth is washed out using the hose and nozzle attached to the ceiling to clean the oral cavity of debris (feed,
etc) which would interfere with intubation. It is done regardless of anesthetic program planned. Hooves are
to be cleaned and scrubbed at this point also. Students should wear disposable gloves for this procedure and
also a smock/coveralls to keep hands and „greens‟ relatively free of contamination prior to surgery.
Surgery Technicians will usually place IV catheters prior to surgery.
Surgery students will wear their smock for the anesthetic induction.
Anesthetic induction will be supervised by an anesthesiologist or the anesthesia technician.
Anesthesia, surgery and O.R. personnel will all help position, pad and prep the patient while students on the
case and surgeons scrub.
After surgery, anesthesia students will monitor the patient at least until it is in sternal recumbency and always
until they are relieved by a surgery student. The intravenous catheter is to remain in place until the horse is
standing, as emergency drugs may be needed in recovery.
All lab coats and coveralls are to be taken off prior to entering the surgical suite.
Students may be required to hose out the recovery stall used by their patient, especially on Fridays and
weekends.
The student assigned to the patient/case will return to the recovery stall to finish recovering the animal.
Patients can be left unattended ONLY when they are steady on their feet and show no signs of post-anesthetic
complications. Return the horse to a bedded stall when safely ambulatory and muzzle the horse.
No sooner than 2 hours after standing from anesthesia, if the horse is showing signs of complete recovery,
then a small flake of good quality wet grass hay may be fed. The reason the hay is wet is to minimize the
chances of the horse choking on dry hay. Following the wet hay a flake of dry hay may be fed. Under no
circumstances, turn the horse immediately into a straw bedded stall following general anesthesia, without a
muzzle on. If any doubt exists about the feeding regimen following anesthesia or any other
procedure/problem, then ASK THE CLINICIAN!
All patients must have a dismissal form filled out with treatment instructions. Special instruction form(s) are
available for some surgeries.
Sterile, commercial intravenous fluid bags are available in the pharmacy. If glucose, Ca, or K is to be added
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to the bag fluids, please have the request to the pharmacy by 3:00 pm on weekdays and 9:00 pm on weekends.
Some DO‟S and DON‟TS
All intravenous injections and catheter placement must be done with a technician or DVM observing.
Intramuscular injections are never to be given to horses in the gluteals, unless requested by an individual
clinician.
Avoid tying horses to the ties in the walls.
Horses being hand walked must have a halter and lead shank in good workable condition. If you need a
blanket for a horse, see barn tech or resident on the case.
Work in pairs, especially with mares and foals and with difficult patients. Mares and foals that are being
exercised outside must be walked by two students. One student is to be with the mare, while the other is to
ensure that the foal does not become separated or begin following after other animals.
Do not walk horses in the parking lot south of the barns, nor exercise or graze on grass lawns.
Above all, keep our hospital neat and tidy as if it were your own. Do not leave trash such as old bandages,
etc. lying on the floor. Clean up all feces as soon as the horse is back in the stall. Avoid leaving blood stains
on the floor and walls of the barn areas.
Keep the records room clean and tidy. Place all records back in the rack as soon as you have finished with
them. Do not bring food into the records room or barn area. Apart from an unprofessional appearance, the
other reason is the presence of nosocomial infections. Diseases such as salmonellosis, and cryptoporidiosis
must be taken seriously. If the outpatient holding stalls have been used (for example stabling a horse while
waiting for radiology) then it is that group's responsibility to clean the holding pen at the end of the day.
Thorough hosing is not required but removal of the gross piles of fecal material greatly assists the night crew.
I. Neurology
The neurology service meets in Room B108 and has formal morning rounds from 8:30 A.M. to 10:00 A.M.
on Monday through Thursday. On Friday Neurology rounds follow Grand Rounds. Saturday and Sunday
morning rounds times will be arranged at the end of each week.
The service is involved with large and small animal cases. Small animal clinical cases and sub animals are
usually housed in ward 6.
Cases examined will come under one of the following categories:

those cases initially received by the service by way of an appointment

in-house cases transferred to the service from another service

in-house consultation requested by another service.
It is imperative that a completed copy of the results of the neurologic examination be placed in the clinican
record of each patient.
71
Cases retained and hospitalized by the neurology service are to be SOAP'ed and treated and the records
completed by the designated rounds time. Students responsible for the case must complete a discharge
summary form (RTG) to accompany the animal home.
Equipment required by all students assigned to neurology includes:

thermometer and stethoscope which are essential for the general examination of the patient

percussion hammer, penlight and hemostat for the neurologic examination

special instruments, e.g., ophthalmoscope, otoscope, etc., will be furnished as needed.
Should free time become available, it is expected that the student will spend it in the library or in other areas
of special clinical interest.
OBJECTIVES for the week include



to become proficient in completing and interpreting a neurologic examination on small and large animals
to become familiar with specific diseases of the nervous system of small and large animals and the
treatment for these diseases
to become aware of special diagnostic procedures available in the detailed workup of neurologic cases.
Special procedures available at CSU include collection and analysis of CSF, special radiographic
examinations, electrodiagnostic studies, nerve and muscle biopsies, and CT scanning.
Students are encouraged to follow up cases after leaving the service and to continue to do neurologic
examinations on cases which they are responsible for on other services which might need a clinical evaluation
of the nervous system.
J. Oncology Service Orientation
You will soon be on the Clinical Oncology Service rotation. These notes are intended to give you an idea of
how the section operates, and outline our expectations of you while on this rotation.
The Clinical Oncology Service is devoted exclusively to the treatment of pet animals with cancer. The goal
of the Clinical Oncology Service is to teach students a realistic and optimistic approach to the diagnosis and
treatment of pets with cancer. We are a very busy service, which allows students the opportunity to be
involved with a wide variety of medical and surgical challenges. We have many ongoing projects and
protocols which may not always appear oriented to the students and private practitioner. Our most important
goal, however, is for you to experience the practical diagnosis and treatment of a cancer patient.
The Clinical Trials Service is a unit of the Clinical Oncology Service. The Clinical Trials Service is
composed of a coordinator, at times a clinical trials intern, and a rotating medical oncology resident. After the
general Oncology Service consults with owners about standard of care treatment options for their pets, a
member of the Clinical Trials Service will consult with clients regarding available clinical trials. The medical
oncology resident assigned to the Clinical Trials Service is the primary clinician for patients participating in
clinical trials, and case management is their primary responsibility. Students may or may not be assigned to
these cases.
The Animal Cancer Center exists to foster more in-depth cancer research into the prevention, causation, and
72
treatment of cancer in pet animals. Special seminars and learning opportunities in the Animal Cancer Center
are available to you when time permits. The Flint Animal Cancer Center is a research facility and, with the
exception of the nuclear medicine area, it does not house pets or increase the case load we currently have.
RECEIVING
We receive new cases and rechecks Monday through Thursday. Please dress professionally (hospital dress
code applies). You are expected to review the next day‟s appointment schedule each afternoon, sign up for a
“Never Been Here” (NBH) case and familiarize yourself with the incoming patient complaints. You may
review the patient‟s record before it arrives for its appointment, but don‟t remove the record from the
reception desk area. Follow your cases thoroughly. If your case is shared with soft tissue or CCU, you are
still responsible for it.
 Report on the patient in Oncology Service Rounds, including results of any medications, procedures,
and tests performed.
 Owner communication is very important on this service. Be sure the responsibility of owner
communication is clearly defined and accepted.
 Fill out histology forms in advance and having them checked by the clinician. Ask an Oncology
Nurse to help you get the samples submitted to the Diagnostic Lab or Clinical Pathology before
3:30pm each day. All of the senior students are issued pagers while on this rotation. Although each
pager is numbered individually, all of the pagers will respond to number 526. Therefore, when paged,
all of the students will be paged at the same time. Please listen for your name, and respond promptly.
You are responsible for the pager that is signed out to you, and should it become lost while in your
possession, you are responsible for replacing it. Please keep your pagers with you while you are on
this rotation. Please turn your pager OFF during rounds. Remember to turn them back ON after
rounds.
RECORDS
Some key points about patient records:




If the patient is an inpatient, place the record in the appropriate slot, do not keep it in the rounds room
If the patient is a Radiation Therapy patient (inpatient or outpatient), house the record in the
appropriate slot and bring the record to Radiation Therapy with the patient each day of treatment.
Records should not be left on the Rounds Room table
When not being used, each record should stay in an appropriate slot in the Medicine Treatment area or
in the appropriate slot in the Rounds Room.
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WEEKLY CLINICAL ONCOLOGY SERVICE SCHEDULE
Monday
Tuesday
8:30
Service
Rounds
8:30
Service
Rounds
Wednesday Thursday
8:30
Radiation
Rounds
8:30
Service
Rounds
Friday
Saturday
Sunday
8:00
Service
Rounds at the
Rounds
discretion of
the clinician
8:30
Grand
Rounds
Service Rounds
9:30 - 10:00
Service Rounds
9:30 - 10:00
Receiving Receiving
Receiving
9:30
9:30
10:00
2:00
Service
Rounds
3:00
Seminar
Argus Rounds
10:00 - 10:30
Receiving
9:30
1:00
Necropsy
Rounds
3:30
Service
Rounds
3:30
Service
Rounds
3:30
Service
Rounds
3:30
Service
Rounds
5:00
Surg/Path
Rounds
(Fall, Spring)
ROUNDS
Morning Oncology Service Rounds begin promptly (see chart for times). If you have a patient(s) in CCU,
plan to review the case before oncology rounds. If necessary, page the attending clinician. This is intended
to coordinate patient treatments and establish a plan for the day. Each morning by 8:00am, you are to have
SOAPed all of your patients, updated their Progress Notes, and you are expected to report the status of each
case during rounds. Your daily Progress Notes will be reviewed by the clinician on each case. Morning
rounds usually begin with reports on the status of hospitalized cases, then a review of the cases due to arrive
that day. When discussing a case in rounds, please begin with the patient‟s signalment, presenting complaint,
current treatment, and current status; then continue with plans for ongoing care. An oncology topic is usually
presented by a clinician following discussion of the day‟s cases. Morning Oncology Service Rounds usually
last about an hour.
We try to begin afternoon Oncology Service Rounds near 3:30pm. Someone will post the actual time of
afternoon Oncology Service Rounds on the chalkboard daily. All radiographs should be brought to afternoon
rounds. Be sure to follow the appropriate procedures for checking out and returning radiographs from
Radiology. Ask the nurses to assist you in obtaining and returning radiographs.
Dr. Barb Powers has a Surgical Pathology class which all students and visitors are invited to attend during the
Spring and Fall semesters. The class meets on Wednesday from 5:00pm to 6:00pm in the Necropsy Rounds
Room.
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In addition to regular Oncology Service Rounds, weekly specialty rounds include:
Day
Time .................................Location
Topic
Mon
3:00-4:00
ACC room 215
Seminar Series
Wed
8:30-9:30
Rounds room or D106
Radiation Rounds
Fri
8:30-9:30
B213
Grand Rounds
THE ONCOLOGY NURSES
The motto of the Clinical Oncology nurses is “If it doesn‟t make you a better doctor, have a nurse do it.”
They will encourage you to try to draw blood and urine samples from patients. They will help you aspirate
masses, measure lymph nodes, collect marrow, select sedatives, change bandages, etc. The nurses will help
you fill out and submit paperwork. This includes Clinical Pathology forms, Diagnostic Lab forms, Surgery
requests, Imaging Requests, CCU reservations, etc. Use the nurses to help coordinate the surgery schedule
with Anesthesia and CCU. Keep the nurses informed of pending surgeries so they can help make sure all the
paperwork is turned in at the appropriate time. The goal of coordinating these tasks to a nurse includes
helping to expedite “the paperwork” for the students. We are also trying to improve the quality of your
experience while on the Clinical Oncology Service. Please don‟t hesitate to engage the knowledge and skills
of your nurses.
Our nurses will often do anesthesia for biopsies or other short procedures. Check with them, and then post the
following information on the dry-erase board in the rounds room:






The client name
The patient location
The procedure
Your name
The attending clinician‟s name
The name of the clinician doing the procedure
One of the Oncology nurses will coordinate the anesthesia time, and make the preparations necessary to begin
the procedure.
The oncology nurses will also coordinate the sedation that is required for ultrasound. Please turn the request
into them and they will take it from there.
SURGERY
The surgery schedule is as follows:
 Monday through Thursday = oncology surgery usually begins in the afternoon after new case
receiving
 Friday = surgery begins in the morning
YOU MUST BE PREPARED TO GO TO SURGERY ANYTIME!
Some key points about surgery
 You must provide your own scrubs at all times.
 Surgery technicians will assist you in the OR
 Observe the rules of the clean and the sterile corridor.
75



Surgical scrubs will be donned at VTH, and not at home!
Booties will be changed before entering the OR, if you have been outside the surgery area.
Lab coats will be worn over your scrubs when you are not in the surgery area.
Your preparation is the key to a quality learning experience
Remember to ask an Oncology Nurse to help you prepare, if you need it
 Anesthesia / Surgery requests are to be initialed by the Anesthesia Pit Boss when the requests are
submitted to Anesthesia (do not just put the request in their box or on their counter).
 SOAP‟s need to be done by 8:00am or earlier and recorded in the record for anesthesia
 Patients need to be in anesthesia 1.5 hours (90 minutes) prior to scheduled table time.
 First wave surgical patients need to be in anesthesia prior to 8:00am
 Many surgeries require the patient to receive antibiotics (often cephazolin). Have the prescriptions
signed by the surgeon and the drugs picked up from pharmacy before surgery.
 CCU orders are to be written and signed and delivered to CCU prior to surgery.
 Pathology requests are to be filled out before surgery.
 Wear your lab coat or smock over your scrubs.
 Take off your lab coat when you are finished clipping.
 Assist anesthesia when moving your patient into the OR
 You should know how the patient is to be positioned on the surgery table.
 If you need to come into surgery for only a short time (to observe, etc) wear a clean surgical gown and
booties over your street clothes (ask a surgery nurse to help you).
 You are responsible for removing „sharps‟ from instrument trays and placing them in the
sharps containers in the surgery suite.
AFTER SURGERY










Once the patient is extubated, it is your responsibility again
Start the surgery report. If the surgery is a complicated one, you may want to have a fellow student
take notes during the surgery
Surgery reports are due to the surgeon by 8:00am the following morning
All tissue samples collected during surgery are your responsibility. Clearly label them and submit
them (with a request) to Pathology. Samples left in surgery will be kept in surgery.
Type a discharge summary (online) and have it signed by the clinician on the case.
Encourage the primary clinician or the surgeon to complete the charge sheet.
All medications going home with your patients are YOUR responsibility. Consult with the clinician
and/or surgeon, fill out the prescription, have the clinician sign the prescription, turn in the
prescription to pharmacy, and retrieve the medications from pharmacy.
Any radiographs that the owner brought should be labeled with the CSU patient number and the CSU
clinician‟s name. Copies of radiographs that are important to the case should be made. Ask the
oncology nurses for help with this.
Return any unused drugs to the pharmacy
CSU Radiographs should be returned to radiology
RADIATION THERAPY PATIENTS
Patients receiving radiation therapy present special concerns for students. Your responsibilities for these
76
patients are outlined below.
 Place a “STUDENT WILL FEED” sign on the patient‟s cage door.
 Green sheet to remove the patient‟s food dish (patients should always have water) at 10:00pm the
evening before radiation therapy days.
 These patients need to be SOAPed early in the morning because they need to be walked and delivered
to Radiation Therapy before 8:00am.
 If a pet develops complications that may influence its safety under anesthesia, please discuss
the situation with a clinician before taking it to Radiation Therapy.
 In addition to writing information in the pet‟s records, write each patient‟s weight, vital signs
and other appropriate information on a small yellow form provided in the Medicine Treatment
room by the Radiation Therapy crew. Affix the yellow form to the record and take the yellow
form, record, and the patient to Radiation Therapy.
 Walk the dogs outside before taking them to the Radiation Therapy room (NW corner of the
building).
 If blood or urine samples are needed, indicate it on the yellow form and provide the Radiation
Therapy crew with the necessary blood tubes and completed Clinical Pathology forms. They
will draw the samples for you and submit them.
 Deliver the radiation therapy patients (with record and yellow form) to the Radiation Therapy
room BEFORE 8:00 in the morning.
 A complete CBC, SADP, and UA are done on radiation patients before, in the middle, and at the end
of the course of therapy to assess changing medical conditions and the effects of frequent anesthetic
events.
 Monitor each patient‟s weight on a daily basis. Be sure to notify the clinician if a patient‟s weight
begins to decrease. It might indicate that steps need to be taken to improve the patient‟s food intake.
 Monitor the patient‟s comfort level. As a team, we are very assertive with patient comfort, and
aggressive with pain management.
 YOU are responsible for the Monday morning SOAP, the case summary, and delivering the patient to
Radiation Therapy for the next student before you change services.
ASPIRATES AND BIOPSIES
Remember: “IF IT‟S WORTH CUTTING OUT, IT‟S WORTH SUBMITTING FOR HISTOLOGY”.
Nearly all surgical resections will have samples submitted to the Pathology Department. The pathologists
need as much information about the patient and the sample as possible to help us arrive at an accurate
diagnosis. Please fill out the histology request form completely including location, size, and extent of lesion,
as well as pertinent history. Fill out requests before obtaining samples, and have a clinician review the forms
with you. A nurse will help you submit the forms and samples promptly.
When doing a fine needle aspirate (FNA) please make two or three slides. Label all slides with the patient‟s
number, the date, and the location from which the aspirate was taken. Check the first slide with a clinician for
accuracy and quality of aspirate. Stain a slide and examine it. If the preparation appears diagnostic (check
with a clinician), the remaining slides may be submitted to Clinical Pathology. Again, fill out the request
form completely. All aspirates must be recorded on the patient‟s physical exam sheet. Details of tumor
location, longest-dimensional size and cytology results must also be recorded.
MISCELLANEOUS (BUT STILL IMPORTANT!)
Draw blood only from the jugular vein unless the clinician instructs you otherwise. The leg veins are used
frequently for radiation therapy anesthesia or chemotherapy. In most cases, urine should be collected by
77
cystocentesis. Exceptions include patients with suspected transitional cell carcinoma of the bladder or other
interposed tumor. Ask a clinician or nurse for help.
Be sure cages are appropriately labeled and cage cards are current. When a patient is discharged, please put
the cage card INSIDE the cage. That signals the cleaning staff to clean the cage.
It is our policy to discourage administering vaccinations to pets who are debilitated or patients receiving
chemotherapy. If a client request vaccination, check with your clinician.
Oncology literature (veterinary and human) is available for loan from various Oncology clinicians, the VTH
Library, and the library in the Oncology Rounds Room.
Oncology patients are generally caged in Ward 3 or the immediate runs outside of Ward 3. We generally use
the North end of the Small Animal Medicine Treatment area for blood or urine collection and patient
processing. Nurses and volunteers are happy to help you prepare a cage for your patient. All patients staying
in the hospital, even for a short time, must have:
 An imprinted cage card which includes the clinician‟s and student‟s name
 A „Student Will Feed‟ sign to hang on the cage
 Fleece
 A bowl of water
 The patient record placed in the corresponding slot in the rack in the Medicine Treatment room. Keep
the patient‟s record in the Medicine Treatment Room. That way it will remain accessible to all who
have need of it.
Please discuss client communication with the clinician on the case and record it on a Client Communication
area in Vet Point so it becomes part of the patient‟s record. You will generally be asked to communicate with
your clients daily. If the client has a long distance phone number, ask a clinician for a long distance access
code.
If you are taking a patient out of CCU, it is important that they leave before 10:30am. If you are unsure
before morning rounds whether a patient will be coming out of CCU, communicate with CCU. Let them
know that the patient may be removed right after rounds. Please, clean the CCU cage and pick up all the
paperwork and medications for the patient.
YOU are responsible for the Monday morning SOAPs, the case summaries, and delivering patients to
Radiation Therapy for the next student before you change services.
KEEP THE ROUNDS ROOM CLEAN AND PROFESSIONAL.
EVALUATION OF STUDENT PERFORMANCE
In an effort to assess student performance while on the Clinical Oncology rotation, we have set these criteria
on which you will be „graded‟.
The general criteria for student performance assessment includes demonstrating
 Preparedness
 Critical thinking and initiative
 Patient care
78




Client communication
Daily case presentation
Knowledge of disease
Teamwork and collegiality
More specifically, a student must
 Demonstrate at least an entry level of knowledge of common malignancies in veterinary oncology and
their related conditions, such as paraneoplastic syndromes. Emphasis is placed on common historical
and clinical findings, diagnostic approaches, staging schemes, therapeutic options, and prognosis.
 Demonstrate at least an entry level of knowledge of commonly used treatment modalities in veterinary
oncology including chemotherapy, radiation therapy, and surgery. Emphasis is placed on the
indications, safe methods of administering each, their toxicities, and supportive measures for each
modality.
 Demonstrate at least an entry level of knowledge of which resources will provide the information
required (books, articles, journals, website, etc)
 Demonstrate at least an entry level of knowledge of common supportive measures used to assist the
cancer patient. This includes the use of antiemetics, nutritional support, and analgesic therapy. The
indications, contraindications and procedures for prescribing each are to be understood.
 Demonstrate at least an entry-level proficiency in client communication and education.
 Demonstrate at least an entry-level proficiency in patient care.
 Demonstrate at least an entry level of knowledge about the cost of treating a veterinary cancer patient.
YOUR EVALUATION OF THE CLINICAL ONCOLOGY ROTATION
On the second Friday of your rotation, you will be asked to fill out an evaluation form. This is an opportunity
for you to express your opinion about the job we‟ve done. We are dedicated to improving the teaching service
and the learning environment we provide for you. We appreciate your input and take your comments (both
positive and negative) very seriously. Please take a few minutes to express yourself.
K. Ophthalmology
This elective is designed to provide the student with an introductory experience in clinical ophthalmology.
Small animal track students will spend 2 core weeks on the rotation and may elect to take additional weeks.
Large animal and general tract students may spend an elective week on the rotation. Students will participate
in patient receiving and ocular surgery. A strong emphasis will be placed on the mastery of examination and
diagnostic tests. Specific rounds times will be scheduled to cover core material.
Hospitalized ophthalmology patients will be treated by the student in charge of the case unless specific
approved arrangements are made with the duty clinician(s). Hospitalized animals must have a daily SOAP in
the medical record each morning by the time rounds begin. Weekend duty will be required as indicated by the
case load.
Objectives
The following objectives are to assist the student toward achieving maximal benefit from the rotation.
Demonstrate and understand the principles and methods of obtaining a medical history as it pertains to an
ophthalmic problem.
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
Demonstrate and understand the techniques and instrumentation used to conduct a systemic examination
of the eye. Instrumentation and tests include: microbial culture and sensitivity of the conjunctiva and
cornea, tear testing, ocular staining tests, nasolacrimal system evaluation, ocular surface cytology/biopsy,
transillumination, tonometry, gonioscopy, biomicroscopy (slit lamp exam), ophthalmoscopy (direct and
indirect), ultrasonography, and electroretinography.

Formulate a temporaryy problem list or differential diagnosis list and suggest ancillary diagnostic tests
that would be appropriate considering the pathophysiology of the problem.

List therapeutic goals and outline a specific treatment regimen for particular cases.

Demonstrate appropriate surgical techniques.
L. Preventive Health Program (PHP)
During the freshmen, sophomore, junior and senior year, each student will be assigned to assist in the
Preventive Health Program held each Saturday morning. Signed up sheets will be circulated in during the
first few days of the fall semester and a schedule will be posted shortly after. Your participation in these
clinics is considered mandatory and you must obtain prior approval for absences and must make up any
missed clinics. If you plan to be absent, you must trade with another student so the service will not be left
short handed. All changes in PHP dates must be emailed to Dr. Ruch-Gallie.
Where to meet B-100
Time
During the academic year we will meet at 8:00 a.m. for orientation and review. Appointments are scheduled
from 9:30 a.m. until 11:30 a.m. During the summer months when only seniors are scheduled, there will be no
orientation and appointments will be scheduled from 8:30 a.m. until 11:00 a.m.
There will be no PHP clinics during the week of New Year‟s, Open House, Spring break, Memorial Day,
Thanksgiving and Christmas.
Dress Clean smock, I.D. Badge, professional attire (see VTH dress code)
Equipment Stethoscope, penlight, thermometer, leash, pen
What to Review (Junior and Senior students)

Vaccination and medical record forms and Veterinary Teaching Hospital immunization schedules in
order to fill out forms correctly and provide information to clients.

Chapter in Infectious Disease of the Dog and Cat by Greene on Immunization. Students should have a
firm understanding of the scientific basis of Immunization.

Class notes on immunization.
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
All parasitology notes applying to small animals (i.e., diagnosis and management of common parasites
in northern Colorado). Students should be able to fill out prescription for treatment of common
parasites in northern Colorado.

All reproductive notes applying to neutering of small animals. Students should be able to provide
information on neutering and declawing.

All notes on canine and feline pediatrics (i.e., should be able to recognize common congenital
abnormalities).

All notes on small animal nutrition. Student should be able to assess dogs and cats diets for nutritional
soundness.

Preventive Health Program notes from VM 714.
What to review (Sophomore and Freshman students)
There is no review information for underclassmen. The intent of clinic participation is to introduce the
VTH, clinics and paperwork.
There are several goals to this exercise:

To provide the student with the primary responsibility of case management, thus gaining a sense of
responsibility for meeting the needs of his/her clients.

To provide the student with responsibility early in his/her training with patients with nonlifethreatening conditions to give the student confidence in the future management of more complex
medical or more life-threatening conditions.
To provide the student with the challenge of pulling material from a number of clinical courses and
applying the information in a clinical setting. Not just an examination, real case responsibility.


To give the student experience with client interaction in a relatively stress-free environment.

To provide preventive health care to CSU clientele.
M. Small Animal Medicine Services
General guidelines
Student and doctors are assigned to the service from 8 am Monday until the next Monday at 8 am. Weekend
assignments will be determined based on caseload and the faculty clinician and so do not make weekend plans
without permission.
Rounds will begin at 8:00 A.M. Monday through Friday unless otherwise specified by your faculty clinician.
It is expected that students will have completed a complete physical examination, treatments, sample
collections, and SOAPs prior to morning rounds. The student should be prepared to discuss their cases during
rounds. Students must be completely familiar with all therapeutic and diagnostic plans for their inpatients.
The medical record and SOAP should be brought to rounds during these case discussions.
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Radiographs and other imaging results should be checked out of radiology (see Radiology Section) for
viewing during rounds. At the completion of rounds the radiographs must be promptly returned to radiology.
Friday morning grand rounds are mandatory for students, interns and residents. When on clinical duty,
faculty members should also attend.
Students are expected to have bandage scissors, clipper blades, thermometer, leash, and be appropriately
dressed for clinic receiving. Students should review the College of Veterinary Medicine dress code prior to
starting the rotation.
Students should keep an index card with the owner‟s information for each case. These cards can be used as
“things to do” cards for each case. Owner information should be verified before the client leaves the hospital.
Students should have all prescriptions and RTG forms completed prior to 5 pm.
Students should review the small animal biosecurity guidelines prior to starting the rotation. Food and
animals or animal byproducts should not be in the same area. Thus, we have chosen not to allow animals in
the rounds rooms. While on the first floor of the VTH you should always wear shoes with closed toes and
your smock.
Appointments marked “PID” (potential infectious disease) the animal may be waiting outside to be seen.
Take the animal DIRECTLY to an exam room. Block off the room, place “Special Disinfection Required”
sign when done (located in Derm Alley) and call animal care at 7-1223 for appropriate cleaning. For
potentially infectious respiratory cases, wear gloves and a disposable gown when examining the patient.
When receiving a new case, try to complete the history and physical examination within 30 minutes. Use a
maximum of 15 minutes to organize your problem list, differential list, and plans. When ready, page your
assigned clinician to discuss the case. Stay on schedule so that your next appointment does not have to wait.
When receiving a recheck case, review the record prior to the appointment. Get an updated history since the
last visit and a brief physical. Find out if current medications are tolerated, verify dosages and determine if
refills are needed. Attempt to spend no more than 20 minutes with the owner prior to paging the clinician to
discuss the case.
Students should meet and then work closely with Maura, JoAnn, Kris, and Amber, the internal medicine
technicians. They can teach many of the hospital and clinical procedures. When on receiving, utilize students
from the non-receiving medicine service to aid in restraint and sample collection so everyone can stay on time
with appointments.
Students and doctors are expected to clean up after themselves. Make sure that sharps are always placed in
the appropriate receptacles.
When admitting a case to the VTH, attempt to send all owner materials home, including collars and leashes.
Place a paper collar on the animal with the animal‟s name, student, and clinician clearly marked. If the
owner insists on leaving bedding, toys, or cat carriers, make sure they are clearly labeled and warn the owner
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that such items may be misplaced and not returned.
Use the blue addressograph cards to mark the cage card. Make sure the cage card is completed fully. Use
signs denoting special instructions like “No food” or “May bite” as clinically indicated. If you find an animal
in a soiled cage, clean the cage. Do not just transfer the animal to a clean cage or leave unattended.
In general, internal medicine organizational rounds are held from 4:00 pm until 5:00 pm. Thus, owners
should be instructed to come after that time unless the faculty clinician adjusts the schedule.
After speaking to owners by phone, make sure to tell your clinician the status of the case and record your
conversation in the electronic medical record (See the POVMR section for more information).
Communications should be recorded in the electronic medical record whether the animal is in the hospital or
has been discharged. While the patient is in the hospital the medical record will be kept in the appropriate
Internal Medicine rounds room.
Make sure to get contact numbers for clients when they leave the pet with the VTH. Don‟t assume the
information in the medical record is correct. Also give the client your name on a hospital business card.
Follow up promptly with test results after patients have been discharged. Document these calls and notify the
clinician. Follow up with a general progress call a couple of days after discharge, at least by the end of the
week.
Small Animal Internal Medicine Schedules
While on small animal internal medicine you will receive new cases, recheck cases, and transfers from the
triage or emergency services.
The following is the general receiving schedule for the internal medicine services. Individual rounds and
appointment times may vary.
Internal medicine schedules
Monday
Tuesday
Wednesday
Thursday
Friday
1
Medicine 1 Transfers,
Receiving
Transfers,
Receiving
Combined
procedures,
procedures,
service:
and
and
Rechecks,
consultations
consultations
transfers,
2
procedures,
Medicine 2 Receiving
Transfers,
Receiving
Transfers,
and
procedures,
procedures,
consultations.
and
and
consultations
consultations
1. Transfers may come from the overnight or weekend emergency service, or from the daily triage service.
2. The typical receiving schedule is new appointments at 9:30 am, 10:45 am, and 12:45 pm. Recheck
appointments are at 2:00 and 3:00 pm. Three appointments are offered at each time slot.
Fridays: Grand Rounds: 8:30-9:30 followed by Internal Medicine rounds
Small Animal Triage students serve as the daytime emergency students. CCU and/ or Triage doctors initially
examine non-scheduled cases with these students. The CCU and Internal Medicine faculty members on
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service then aid in determining the most appropriate service for the case to be transferred to.
The students on Triage must respond to pages from the front desk or operator within one to two minutes after
receiving the page.
Small Animal Medicine Block Grading for Weekly Rotations
At the end of the rotation, the faculty member on each service will give all students the opportunity to
evaluate the clinicians and will coordinate the grading of the students. A pass/fail grade with grading score
added into your ranking will be given based on clinical aptitude, general knowledge, patient care, attitude and
interpersonal skills and rounds or records. A failing grade will be rectified by use of the College of
Veterinary Medicine and Biomedical Sciences guidelines.
Problem Oriented Veterinary Medical Record (POVMR)
The medical record is a legal document, thus it is imperative that it be filled out completely. Writing the
medical record enables the student to approach problems in a logical, problem oriented manner. Reading the
completed medical record lets the clinician objectively evaluate the student. It is imperative that students learn
to keep complete records and follow the guidelines taught in the junior practicum. The internal medicine
faculty require SOAPs to be typed, signed, with the case number included, and placed in the medical record
after clinician review.
Small Animal RTG forms
For legal and instructional purposes, all clients should be given an RTG form. We would like the students to
complete these using the VTH electronic system as described below. The student should anticipate discharge
and have the RTG ready for review by the primary clinician at least 1 hour prior to discharge.
To access the electronic RTG:







Select VTH Patient Information from the VTH homepage (www.vth.colostate.edu).
Enter the patient case number or client last name.
Click on the current invoice link (the first one in the list is always the most recent).
At the bottom of the page, click on Medicine RTG. Do not select the “Finalize” link just below as this
is for clinicians only.
At the login prompt, enter student as the login ID and *student as the password (some of the x-stations
have these fields automatically filled out).
Complete the form and click on Create Document.
You may print the completed form on any printer.
To edit an already completed RTG form:



Click on Medicine RTG, after accessing the client invoice as above.
Click on the Word icon that is long the top of the page where the other browser commands are listed,
e.g., Back, Forward, etc.
A new window will open which contains the RTG in an edit mode where you can make any necessary
changes.
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

When finishing editing, Save the file. You can then close this window. Please note that the old RTG
will still appear and will not contain your edits.
To display and print the newly edited RTG, you must return to the invoice page and select Medicine
RTG again.
In Colorado, we have many infectious agents that can be transferred between animals or between animals and
people. Some of these agents like Yersinia pestis, rabies, Salmonella, and Giardia are direct zoonoses.
Students, staff, and doctors should wash their hands or use hand-sanitizer after each patient. Students should
carefully read the biosecurity guidelines prior to starting the rotation.
http://www.vth.colostate.edu/vth/biosecurity/index.htm.
Small Animal Wards and Receiving
General guidelines
Wards and receiving duty is part of the PVM training program. The performance of the student will be
monitored by the house officer on duty. Problems will be reported to the internal medicine backup faculty
member on duty for appropriate action.
If a problem for the student arises, bring it to the attention of the house officer on duty and/or the internal
medicine faculty member on back-up.
Wards and receiving duty is from 5 pm to 8 am on weekdays and either 7 am to 3 pm or
3 pm to 8 am on weekend days.
Wards and receiving students on evening duty will be allowed to leave the hospital at 11 pm when all
treatments are completed, all emergency cases are stabilized, and when approved by the house officer on duty.
You may be required to stay after 11:00 pm by the ER doctor and you may be called back in to the hospital if
your help is required on patients arriving after 11:00 pm. A walk-through of the wards and exotics is required
prior to leaving at 11:00 pm.
After the wards and receiving students have completed evening duty and are approved to leave the hospital,
they will remain on call until 8 am. The student must record phone and/or beeper numbers on the call list
posted outside of CCU for easy access if needed for further emergencies.
At the start of your shift, sign out an emergency beeper at the front desk and then meet with the house officer
on duty in the last examination room (by the wards) for a brief orientation.
Your primary service clinician should allow you to leave for wards duty at 5 pm. If you for some reason are
unavoidably detained, please inform the house officer on duty of your location.
Pages from the front desk should be answered within a maximum of 1 to 2 minutes. Immediate response is
imperative when emergencies enter the hospital. Wards and receiving students must be in the hospital (not
upstairs) for the entirety of their shift unless permission to leave is given by the house officer on duty.
If a schedule conflict occurs, it is the student‟s responsibility to find a replacement or make a trade. Debbie
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Liptak in the Clinical Sciences departmental office (297-0384) and the small animal reception desk (2974476) must be informed if a schedule change is made. Students must ultimately complete all assigned shifts.
Students are not permitted to pay (or barter with) other students to take their assigned duties.
Meals should be consumed in appropriate areas of the hospital. Food or drink should not be consumed in the
same areas where animals are present or treated.
Since food and drink are consumed in the rounds rooms, animals are not allowed.
If not busy, the wards and receiving students should check with CCU to see if help is needed.
There are 4 major areas of responsibility for the wards and receiving students.
Emergency case receiving
Patient care and treatments of animals in the ward
Information calls
Patient discharges
Emergency case receiving
When an emergency case arrives, assess the patient first to decide if it needs immediate medical attention. If
so, immediately transport the patient to the critical care unit (CCU). Do not allow the owner to accompany
you. All trauma cases, suspected gastric dilation and volvulus cases, bleeding animals, snakebites, and
seizuring animals should immediately be transported to CCU.
After transferring the case to the CCU staff, return to the reception area to take a complete history. Check all
telephone numbers and collect any additional numbers that are not in the record.
For emergencies that are not immediately life-threatening, alert the house officer on duty, enter an
examination room, complete the history and physical examination, and make an initial plan.
Do not let the client leave the VTH without meeting the house officer on duty.
Emergency cases are the admitting student‟s responsibility until the case is transferred at 8 am the next
weekday. For example, a patient received in at 7 pm Friday night is the responsibility of the receiving student
until 8 am Monday morning. Thus, wards and receiving students should not make plans to leave town when
on any weekend duty shift.
Wards and receiving student responsibilities for emergency cases include but are not limited to: assisting
CCU staff with stabilization if needed, helping the radiology technician take radiographs if needed, record
keeping (SOAP), client communication, and green sheets (if the animal is housed in the wards).
If the technician has left for the evening, an on-call radiology technician will be called in to obtain
radiographs.
If an emergency case goes to surgery, the surgery back-up students take over full responsibility for that
patient.
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The emergency caseload should be shared equally by all wards and receiving students on the shift.
Wards treatments
Wards and receiving students are to perform treatments as scheduled by the primary student using the medical
record‟s "green sheet." The primary student should enter the proper information from the patient
identification card, the patient's problem, the date, the cage or run number, the clinician‟s name and phone
number, the primary student‟s name and phone number, and the treatment instructions. Treatment
instructions must be legible, complete and accurate. Remember that the “green sheet” is part of the legal
document.
The completed "green sheet" should be placed on the treatment counter in the ward in which the patient is
located. Medications (tablets, ointments, injectables, etc.) should be placed on the "green sheet" with tape
except in those instances when the medication must be refrigerated. When refrigeration is required the entry
"medication is in the refrigerator in the medicine treatment room" should be written on the "green sheet". All
controlled drugs must be logged on the purple sheets in pharmacy and on the patient‟s green sheet.
The primary student should fill out white cards to be placed in the appropriate time clips on the After-hours
and EM Treatment Board (which is located on the west wall of the medicine treatment room). Appropriate
treatment times follow. While multiple treatment times are available on the weekends and holidays, it is
expected that the primary students will also be evaluating their cases during the day.
Mon – Fri
10:00 P.M.
Sat, Sun, Holidays
1:00 P.M.
3:00 P.M.
7:00 P.M.
10:00 P.M.
Wards and receiving students should check the After-hours and EM Treatment Board at each BID/TID/QID
treatment period and perform the treatments on the designated patients as instructed. Read the parameters on
the green sheet carefully and follow the instructions.
If there are any concerns, contact the student listed on the green sheet. Do not make decisions on your own
that contradict the instructions on the green sheet without contacting the student, primary clinician, or house
officer on duty.
Appropriate entries should be made on the "green sheet" to indicate that the requested treatments were
accomplished and the person performing the treatment should sign the "green sheet" for each treatment given.
On the day after treatments have been performed by the wards and receiving student the primary student
should place the "green sheet" in the medical record.
Any concern about the physical condition of an animal in the wards should be brought to the immediate
attention of the house officer on duty.
If you note an animal in the wards in a dirty cage, please clean it. Do not just move the animal to a different
cage, clean up the one it is in.
87
On weekdays, animals should not be “green sheeted” for treatments or walks at 7 pm. The primary student
should treat and walk the animal before leaving the hospital.
Extended treatments like hot packing, tube feedings, or bandage changes are the responsibility of the primary
student and are inappropriate for “green sheeting”.
All treatments must be completed before the wards and receiving students are authorized to leave the hospital.
Treatment load must be shared by all students on each wards and receiving shift.
Information calls
Information calls are an important part of PVM training and a great service for clients.
Make sure all information for each call is recorded on the log sheets in the triage / outpatient rounds room
(including phone numbers). Any questions that you can not answer, please talk to the clinician in charge.
Remember, you can not diagnose or suggest treatment over the phone.
In an extremely obvious emergency, the client should come in immediately. Advise the house officer on duty.
If an owner calls and believes that their animal has an emergency and needs to be seen, it is hospital policy
that they will NOT be discouraged from coming in on emergency. The client should talk to the house officer
on duty if the client has a question about coming in or waiting until business hours.
Alert the front desk when a case is to be admitted. Transfer the owner to the front desk to allow for
generation of a record prior to arrival.
Discuss the advice that you gave over the phone with the house officer on duty and make sure that it is
documented on the log sheet.
AFTER determining whether the case is to come to the VTH on emergency, make sure clients are aware there
is an $89 emergency fee for the initial physical examination and consultation (with clients frequently
incurring additional charges for diagnostics and therapeutics). The house officer on duty (with approval by a
faculty member) has the authority to waive the emergency fee for established clients (i.e. a complication,
status deterioration, euthanasia etc.) but this cannot be removed from the bill until the next working day.
With permission from the house officer on duty, try to contact the primary clinician by pager and home phone
number if there is an urgent problem with one of their patients.
Information calls should be shared equally by all students on that shift.
With the exception of emergencies, the VTH works on appointment only basis. Unless an unscheduled
emergency, all appointments should be scheduled through the reception desk after 8 am the next working day.
The owners should be told that appointments may or may not be available.
Patient discharges
Primary students and clinicians on cases should perform their own discharges with few exceptions.
88
If it is necessary for a wards student is to perform a discharge, the primary student should:
A
B
C
D
E
F
G
Completed the discharge instructions completely.
Contact the owner by phone to explain the case management prior to discharge.
Explain to the owner the discharging student is not directly involved with the case.
Find a specific wards student before leaving for the day to explain the discharge.
Leave contact information (phone number, beeper number) when leaving so that contact can be
made if there are problems with the discharge.
Have all prescriptions ready
Make sure animal is clean and presentable
If the wards and receiving student has problems with a discharge, the primary student or clinician should be
contacted immediately. If they cannot be reached, please contact the house officer on duty.
N. Small Animal Surgery Services
SMALL ANIMAL SURGERY SERVICE SCHEDULE
7:45
MON.
--------
TUES.
--------
WED.
--------
THURS.
--------
FRI.
Case Rounds*
8:30
Case Rounds*
Case Rounds* Case Rounds*
9:00
--------
--------
--------
Case Rounds* Grand
Rounds
---------------
9:30
A-B Receive
A-B Surgery
A-B Receive
A-B Surgery A-B Surgery
12:00
Lunch
Lunch
Lunch
Lunch
1:00
A-B Receive
A-B Surgery
A-B Receive
A-B Surgery A-B Surgery
4:30
A-B Rounds
A-B Rounds
A-B Rounds
A-B Rounds A-B Rounds
Lunch
*On special occasions (i.e., to accommodate seminars, meetings, etc.) rounds may be held later. Times will
be posted on the chalkboard in each rounds room.
Students should read elsewhere in the hospital Procedures Manual pages for POVMR, S.A. Receiving
Procedures, S.A. Surgery Assignment, and S.A. Operating Room Procedures; concentrate on Receiving
Procedures and S.A. Surgery Assignment.
89
Times to Remember

At 8:30 A.M. Monday of your first week on small animal surgery, meet in your respective rounds
room for case assignments (B-102 Orthopedics and B-107 Soft Tissue). If you begin on an orientation
week, meet in A-221 at 8:30 a.m..

Friday rounds begin at 7:45 a.m. in B-102 (Group A) and B-107 (Group B).

Preparation for surgery will commence at 9:00-9:30 A.M. Monday through Thursday; surgery students
will help anesthetize and clip the first group of surgeries on these days. Surgery will commence at
9:30 A.M. on Fridays, directly following grand rounds.

Receiving commences at 9:30 A.M. and continues through the morning. There may also be some
recheck appointments starting at 1:00 P.M.. Although no appointments are scheduled for the noon
hour earlier cases often hang over into this period. The message is to bring your lunch or plan to eat in
the lunch room. If you have an urgent need to leave during the day check with a faculty person or
resident on the service.

Afternoon surgical rounds are usually conducted by each surgical group Monday through Friday, but
the time is variable and will be posted on the blackboard of the rounds room. Afternoon rounds on
receiving days are generally held at 3:00 or 3:30 P.M..

Weekends/Holidays: Saturday A.M. rounds will be conducted by each group at 8:00 A.M. unless
another time is announced on Friday. No formal rounds are held on Sundays or holidays. Residents
are available to answer questions from 8:00 to 9:00 A.M.; always feel free to call the responsible
clinician on any case.
Grading System
Senior students are evaluated primarily on their reliability, contributions to rounds, performance in seminars,
out of rounds collection of information, records, examination and diagnosis of client cases, care of patients,
and surgical skills. These areas are reviewed by faculty, residents, and intern on duty during the time the
student is assigned to small animal surgery. A temporary grade is determined at the end of each week and an
official grade is turned in for each completed rotation. Grade and comment sheets are available in the Clinical
Sciences office.
Evaluation of Surgeons
Students will be requested to fill out faculty, resident and service evaluation forms at the end of each block.
Animal Housing and Care
Client owned animals may be housed in the wards or "outside" run area. The A service primarily uses ward 4,
and the B service ward 5. Place animals in these wards when appropriate size cages/runs are available.
Animals that weigh more than 30 pounds should be housed in cages on the bottom rows to prevent injury to
attendants or animals. When animals are moved from one cage to another, the cage the animal was removed
from should be cleaned.
Animals will be fed by animal care attendants in the early evening unless instructed not to. Tag the cage
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according to the tag display in the treatment area. Client animal wards are cleaned between 5:00 P.M. - 2:00
A.M.
All animals must have an identification collar with rolodex information on it. Each animal must also have a
cage card with rolodex information stamped on it, student's and clinician's name, diagnosis, and body weight.
In order to help maintain a cleaner, professional appearing hospital, students are asked to clean up their own
work and animal holding areas during the day. Each person will clean up his/her own mess.
All record notebooks should be kept in the wards when not in use; do leave them in the rounds rooms.
Anesthesia students must have access to these files to SOAP their patients prior to surgery.
Small Animal Surgery Assignment “Pearls”

Students assigned to Small Animal Surgery will be placed in one of two groups: Group A
[orthopedics], or Group B [general surgery]. Refer to the bulletin board outside Oncology rounds
room [B104] for your assignment. Rounds rooms are: Group A: B-102, Group B: B-107.

Students that have an unexcused absence from daytime clinic duties or rounds will be reported to the
service head and may have to repeat the week or be required to present a topic to the surgery group.

Students will maintain a clean and neat attire at all times. On receiving days a shirt, tie, and trousers
(not blue jeans) will be worn by male students and comparable dress is required of the female students.
Remember however that you will often have contact with clients on non-receiving, so maintain a
professional appearance at all times.
On weekdays students will do a physical examination (including body temperature) and treat all
hospitalized cases before morning rounds, and record all data using the SOAP method. Dogs may be
placed in outside runs or exercised on a leash in the outdoor fenced area for 5-10 minutes at this time.


The surgery schedule should be checked prior to 8:30 A.M. to determine if any last minute changes
have been made. Surgery animals should be placed in C-108A cages with their clinical records by
assigned surgery students one hour prior to assigned surgery time (or prior to case rounds for first
wave cases).

All in hospital cases should have a 3” X 5” card placed in the metal/plastic flip chart in each rounds
room. Information needed on the card includes owner‟s last name, clinician‟s last name, student‟s first
name, and the diagnosis. Cards are organized by cage number.

On Saturdays, Sundays, and Holidays, ward duties begin at a time that will allow SOAP‟s to be done
by 8:00 A.M. (unless clinician indicates otherwise). All students work Saturday A.M.; however, on
Saturday P.M., Sunday A.M. and Sunday P.M., you can divide up case treatments with other students
on your group. Responsibility for treatment of each case still rests with the student to whom it was
officially assigned.

All surgery request forms must be filled out completely and turned in to the anesthesia service by 3:00
P.M. the day prior to surgery. Turn in a request even if surgery is not certain; it‟s easier to pull a
request at the last minute than to add one.
After admitting a case for Anesthesia/Surgery

The animals location should be clearly marked on the anesthesia request form so the anesthesia
91
student can find the patient record.

In hospital patients need to be available after 4:00 P.M. so anesthesia students can SOAP them.

Patient records need to be in the correct slot (slots in the round rooms) after 4:00 P.M. so the
anesthesia student can find the patient record.

Lab work needs to be available in the record or indicate clearly on the record when it was submitted to
Clinical Pathology so anesthesia students can plan a proper anesthetic regime.
Every effort must be made to operate at the scheduled time. The anesthesia team will normally preanesthetize and anesthetize all patients listed in the surgery schedule. A great deal of anesthesia time can be
saved by pre-clipping the animal. This is especially true of the breeds with a dense undercoat. A close clip
may not be possible, but even a rough clip of the lateral side of the limb can save 10 minutes of anesthesia.
At the termination of surgery, the surgical student should make sure that all sharps are removed and placed in
an appropriate sharps container [attached to the wall in each surgery suite]. Be sure all of the instruments are
in the packs as the personnel at Central Supply will count all instruments when they are returned. If an
instrument is missing it is either in the laundry, garbage, or patient. Rapid and appropriate action must be
taken if instruments can not be accounted for.
An "operative record" must be completed/filed with the Hospital record within 24 hours on all cases operated
in the surgery suite. The case record will be "SOAPed" the evening of the day of surgery.
Clinicians or students will contact clients postoperatively. This varies from clinician to clinician. Be sure and
ask if you are not sure who is to call the client; don't contact clients on your own initiative, rather coordinate
calls with the responsible clinician.
Every animal examined at the VTH, either "in" or "out" patient, must be examined by a DVM in addition to
the student. Each case should be SOAPed and a problem list/plan completed by you before asking a clinician
to see it.
Students will return to the wards prior to P.M. rounds (if possible) Monday through Friday to monitor cases.
Each case will have its temperature taken and required treatments administered. During P.M. treatments, all
dogs will be placed in runs or taken outside for a sufficient time to urinate and defecate. Weather permitting,
exercise dogs outside (enclosed area) at least two times daily; three times daily is better.
Patients scheduled for surgery the following day must have a red tag (off-feed) placed on their cage. Water
can be left in the cage. When returning an animal to its cage after surgery do not place water in the cage. The
animal will be well hydrated and not require water by mouth for several hours. Large breed dogs should not
receive water until the next morning, and then only in small quantities. Large breeds should resume feeding
very cautiously, with multiple small amounts.
If a case requires treatment at times other than between 7:00 A.M. and 5:00 P.M. a green sheet listing specific
treatment(s) should be placed on the counter in the ward, and the location of the case to be treated,
corresponding case number, client‟s last name, and time of the treatment should be written on a piece on cloth
tape and placed on the Master Board on the east wall of the Medicine Treatment Room (B-100). Attach
92
medications to the green sheet if possible, or give explicit directions on where it can be located. The EM and
wards and receiving students will do these treatments (7:00 P.M. and 10:00 P.M. treatments only). When you
are the Wards and Receiving or EM student doing this task, please sign the green sheet to assure treatment has
been performed. The schedule for wards and receiving is located on the locker room bulletin board and
behind the reception area. If you change your wards and receiving duty, please change it on these schedules
as well.
All animals should be kept groomed unless there is some medical/surgical contraindication. Grooming
includes combing, nail clipping, and cleaning ears when necessary. Soiled animals will require bathing. The
cleanliness of animals to be discharged must be checked in the A.M. preceding their dismissal. Students will
bathe their own cases. This may require some help from your service mates if your surgery schedule is tight.
Kennels/cages are to be cleaned any time they are found to be dirty and empty water pans are to be filled.
Newly admitted/assigned cases should be given water at the time of entry. All cases should be checked
during the P.M. treatment period, to see if adequate water is available.
Special diets or supplemental feedings will be fed as indicated by the student assigned. Young animals are to
be fed B.I.D. or T.I.D. depending on their age. Be certain the cage card is completely and accurately filled out
to insure proper feeding. If you place a STUDENT WILL FEED sign on the cage remember that it is your
responsibility to do it.
The only equipment to be kept in wards is a bucket, sponge, cleaning/disinfecting solution, newspapers, waste
container, broom, cat/litter/trays. Everything else is to be returned to its proper place.
If a patient is found dead in a cage, it should be properly identified and placed in the necropsy cooler, on the
side closest to the necropsy floor. The record, with appropriate notations, should be placed in the rounds
room, and the responsible clinician should be advised as soon as possible. If that clinician cannot be
contacted, the on-duty resident/intern should be appraised of the situation.
Preparation required on cases ready for dismissal: Bring financial sheets to the Business Office in early A.M.
of discharge day. Bring the rest of the record and Dismissal Form (RTG Sheet) at the same time, or as soon
as you complete it, and leave it at the Business Office. Medication to be dispensed should be placed on the
shelf in the west window of the Business Office. Turn in unused medications to pharmacy for credit to the
client. Try to get animals picked up between 9:30 A.M. and 5:00 P.M. whenever possible and preferably when
you will be free to talk with the owner. If an evening discharge is necessary, the client should arrive before
10:00 P.M.
Two students will be assigned to Surgery Back-Up duty 5:00 P.M. - 8:00 A.M. daily and 8:00 A.M. to 6:00
P.M. or 6:00 P.M. to 8:00 A.M. Saturday, Sunday, and Holidays. A duty roster will be distributed during the
orientation session at the beginning of each block, and posted on the bulletin board outside B104 and on the
bulletin board behind the receptionists' desk. Students are "on call" during their assignment at the phone
number they list on the duty roster. Another small animal surgery student will be assigned to wards and
receiving 4:30 to 11:00 P.M. weekdays and all day on Saturday and Sunday. Students must remain in the
hospital during these assignments. Please put your phone number on the duty roster at the beginning of the
rotation. A copy should be given to the reception area and bulletin board outside B-104. If you change your
Surgery Back-up time, please change it on the schedules in the reception area and bulletin board. Failure to
be able to contact students for an emergency surgery will result in an incomplete for that week.
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Checking out radiographs from Radiology
If everyone is to have easy access to x-ray films, it is mandatory that certain procedures be followed by
everyone at all times.

Current Day Cases: Films taken the day of the request, as well as films taken previously on that case,
are kept either in the reading room or in the file in the south window of radiology reception in red
plastic folders throughout the day of the exam. These films may be checked out in the red plastic
folder by signing them out on the clipboard in the reading rooms for a 4 hour maximum time limit. No
current case films (films taken that day) should be out of Radiology overnight.

Films for morning rounds Mon. - Thurs. can be picked up at 8:30 A.M. if a blue request slip has been
filled out and turned into the Radiology Reception area prior to 7:45 A.M.

Friday A.M. rounds: Films can be picked up at 7:45 A.M. if request is turned in by 3:00 P.M. the
previous day. Films must be returned to radiology by 8:30 A.M..

Films for afternoon rounds: Films may be picked up at 3:00 P.M. if a blue request slip has been filled
out and turned into the Radiology Reception area prior to 2:00 P.M.

Emergencies/Owner Viewing: Films will be issued upon receipt of blue slip request.

All films should be returned to Radiology as soon as possible after use. There is a 4 hour limit on all
film checkouts to students. Special needs should be discussed with the Radiology receptionist to
receive approval for a longer checkout period, i.e., grand rounds, photography, etc.

Referral films: Be sure name and address of referring vet is on envelope so the films can be returned.
Minimum Data Base
Certain laboratory data is required on all cases going to surgery:
Elective surgery under 4 years
All other surgery cases
= PCV, total protein, urine sp. gr.
= CBC, pre-surgery panel, UA.
Please collect blood for lab work from the jugular vein. Samples for panels must be in by 12:30 P.M. to be
back by 4:30 P.M. Can also turn them in by 8:30 A.M. to be done at 9:30 A.M.
Protocol for Surgical Attire
Surgery students will wear street clothes (and smock) during rounds, clipping, and anesthetizing of their first
surgical case of the day. After the first case is ready to be prepared for surgery, the surgery student will go to
the locker room and put on scrub clothes [clean scrub clothes are your responsibility], shoe covers, caps,
masks and/or hoods prior to entering the "clean corridor" in the surgery area. Please do not use the hospital
scrubs; these are supplied for faculty and staff only.
If the student has to leave the clean surgical area or clean hall, the scrubs should be covered with a used
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surgical gown or smock, and shoe covers should be removed at or near the clean hall door. Upon returning to
the clean hall, students must put on clean and intact, or new, shoe covers and hang their outer garment on the
hook rack next to the clean hall door.
Junior students will change into scrub suits in the upstairs locker room, and then enter the surgery area
through the locker room, where they can obtain caps, masks and shoe covers.
Do not place sharp objects (glass, needles, suture, or hypodermic, scalpel blades, etc.) in the trash, laundry or
on instrument trays. There are receptacles for "sharps" in each surgery room.
Keep feces, tissue, and blood clots out of the laundry. This type of material can be rinsed off in the janitor‟s
closet just outside the locker room doors.
Information relative to your cases is confidential, between you and the client. Do not talk in specifics about
your cases outside the hospital.
Grand Rounds: The schedule for Grand Rounds is posted on the bulletin board outside B-104 rounds room.
Please note if and when you are scheduled to give your case. It is not necessary that you use a case from the
service you are on during the week of the presentation. For purposes of follow-up, it might be better to use a
case from earlier in the rotation.
Small Animal Operating Room Procedures
Scheduling Surgery - Instructions for Filling Out Surgery/Anesthesia Request Forms
Date = date of surgery/anesthesia, NOT the date you fill out the request.

Procedure - please use proper terminology, i.e., "bladder stones" is not a procedure; the procedure is a
cystotomy. For limb fractures/amputations, please indicate which leg and bone, ie., NOT "broken
leg", but "fractured right humerus".

If the surgeon and the clinician are not the same person, please include both names.

Please correctly identify the patient and include the right cage number. Update the cage number if the
patient is moved; otherwise anesthesia service will not be able to find or anesthetize your case.

Have the animal's record (with the blood work) available for the anesthesia student, preferably in the
appropriate ward record rack.

If the surgeon has told you a specific time requirement, please indicate this under "A.M." or "P.M.",
otherwise leave it blank.

If your patient needs x-rays while under anesthesia prior to surgery, please include this along with the
procedure, e.g., "skull radiographs and left hemimandibulectomy". Also check the “pre-op rads” box.

Requests are due by 3:00 P.M. the day prior to surgery/anesthesia. If you have an emergency surgery,
please speak to anesthesia service and fill out a request as soon as possible, and they will
accommodate you. If you have an "add-on" anesthetic, i.e., one you do not know about until the day
of surgery/anesthesia, please speak to anesthesia service and they will accommodate you if they have
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enough students. DO NOT simply put requests into the box for surgery/ anesthesia requests that same
day (without speaking to anyone), or anesthesia service may not see it and as a result it will not be
done.
O.R. Schedule

Anesthesia personnel will make the O.R. schedule from the information on the Surgery/Anesthesia
requests. If a procedure is not on a Surgery/Anesthesia request, it will not be placed on the O.R.
schedule. Life-threatening emergencies are the only exception.

The schedule will be posted on the bulletin board by 5:00 P.M. Monday through Thursday and on
Monday morning ASAP.

No changes are to be made on the O.R. schedule by anyone but the anesthesia supervisor [“pitboss”].
If you wish to make a change, notify this person.

During regular hours, no surgery will be done in the O.R.s unless it is properly scheduled with the
anesthesia supervisor and surgery techs. Surgery will not be performed at any time by students, unless
they are working under the supervision of a staff surgeon.
Operating Room Procedures

Before starting to scrub--open your gown and gloves on gowning tables provided. There is a supply of
gowns and gloves in each surgery room and in the elective room.

You are responsible for returning all used surgical instruments to Central Supply immediately upon
completion of the procedure. No excuses will be accepted.

All sharps (needles, blades) are to be disposed of into sharps containers provided in each surgery room
prior to returning sets to Central Supply.

Please save the aluminum packages for suture during the major surgical procedures and leave them on
the counter in that room when finished. This aids us in determining charges.

Under no circumstances are gowning tables (carts) or heating blankets to leave the surgery area.
Prep Protocol
The person prepping the patient will wear greens, cap, mask, shoe covers, and a hood if hairstyle indicates.
General Prep Technique

Do not clip animals in the surgery suite. If the clip proves inadequate, return to the prep room.

Do not use clipper heads in the prep room to clip abscesses.

Spray clipper head with Oster "Spray Lube" before using. Repeat periodically as necessary to
maintain good operation of the clippers.

If your blade does not cut, remove it, wipe off the contact surface of each blade, reassemble, and spray
with Spray Lube. The most common reason for blades not cutting is hair wedged between the blades.
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
If your blade is dull, return it to Central Supply and trade it for a sharp one.

Each clipper is to be cleaned and lubricated after each use.

Clipping - Check for adequate clipping. The surgical area should be clipped close and at least 4"
wider than the incision. If the clip is inadequate, return patient to prep room for additional clipping.
Check the urinary bladder to be sure it has been expressed prior to abdominal surgery or other long
procedures. Ask for assistance from the surgery technician if there is any question as to the clip or
technique in expressing the bladder.
Scrub
The purpose of the soap scrub is to mechanically remove gross contamination from the skin. Scrub skin,
as illustrated on the next page, with gauze soap pads. Remove the soap with dry sterile sponges in the
same manner. Repeat these steps until the sponges show no more dirt, or a minimum of three times.
Scrubbing the patient

Start at the incision site, using circular motion, and work toward the periphery.
When you reach the hairline, use partial strokes to wet down the hair around the edges.

Discard sponge.

The circular pattern is preferred as this is believed best for getting down into the hair follicles.

Remove soap with dry sterile sponge, starting at the incision site and working toward the periphery
using a spiral pattern. Do not scrub as this is irritating to the patient's skin. Whatever area is involved,
always remember - work from the incision to the periphery (i.e., from "clean" to "dirty") and never
backtrack. This would drag organisms from the dirty into the clean area.

Extremity Prep

Cover all distal hair on the limb with non-sterile glove or adhesive tape.

Secure glove to skin by taping.

Using a second piece of tape, suspend limb from IV pole.

Prep as described above, choosing a pattern that starts at the incision site and works away from it.

Suspend the limb with adhesive tape from a ceiling hook or infusion stand prior to scrubbing.
Principles of Asepsis:

People are the worst source of contamination

No one is to enter the surgery suite at any time without greens, cap, mask, and shoe covers.
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
Surgical attire is put on in surgery locker room suites. Street clothes should not be worn underneath
scrubs.

Limit traffic and activity in the surgery room.

Limit talking to discussions pertinent to the surgery.

Keep gloved hands above your waist and below shoulders and in front of you at all times.

Avoid:
o reaching over a sterile field with an non-sterile object, hand or arm
o
passing a sterile field with your back to it
o
walking between 2 sterile fields; sterile person and sterile field
What is "considered" sterile?

A draped table - the table top only.

Gown of scrubbed-in person from breast line to waistline and fingertips of gloves to elbows only.
What is "considered" contaminated?

Prepped skin - avoid touching it with your gloves.

A dampened gown or drape.

The edge of anything and a 2" border around drapes, wraps, etc.

When in doubt - it's contaminated!

Sterilized equipment is sterile to a particular case only, and is not to be used for more than one case!
Aseptic Opening and Transfer of All Surgical Equipment

Always check the date on the pack.

Cloth wraps are sterile for 6 months.

Nylon wraps are sterile 1 year.

Autoclave tape has black lines on it when it has been exposed to steam.

Green ethylene oxide tape acquires red lines when it has been exposed to this gas.

Always check the steam clock inside each steam autoclave pack. The color will change from green to
black when sterile.
Nylon Wrapped

Do not contaminate the cut edge of the nylon wrap while removing the autoclave tape.
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Do not let the cut edge of the nylon wrap touch any area of the wrap.

Be especially careful not to puncture the nylon when removing instruments with sharp points. These
may slip out of the protective 3" x 3" sponge covering the points. It is easier to remove these
instruments "points first", instead of "handles first".

Watch that the surgeon does not touch the non-sterile nylon wrap.
Cloth Wrapped

Pull off tape to prevent staining the cloth when it is laundered.

Do not lean across or reach over a sterile field to give an instrument to a surgeon or to open a sterile
pack.

Usually you will open the wrap to allow the surgeon to remove the instrument. If it is necessary for you
to place an instrument on a sterile field, pull the sterile cloth wrap around your hand, hold the
instrument above and not touching the sterile field, and drop it.

When using the cold sterilized pick-ups, do not turn them upside down. The liquid runs down to

the handle. When the pick-up is returned to its proper position, the contaminated fluid runs from the
handle to the tip.

Aseptic Transfer of Liquids
Never pour from a small PSS bottle with a red rubber stopper. The mouth is contaminated.


Pour from bottles with stoppers that cover the mouth of the bottle.
o Do not lay the cap down; hold it upright in your hand
o Do not hold the bottle over the sterile field.
o Hold the bottle high to prevent touching the sterile container.
o The cap should be replaced aseptically.
Withdrawing fluids from a bottle with a syringe.
o Wipe the top with alcohol to remove gross contamination. The needle could carry such
contaminants into the bottle.
o Inject the same amount of air into the bottle as the fluid you plan to remove. This prevents a
vacuum from forming in the bottle.
o When placing two liquids in the same syringe, withdraw the first liquid. Draw one ml of air into
the syringe then insert needle in second bottle. This prevents the first fluid from being drawn into
the second bottle when the needle is inserted. After the second fluid is withdrawn, expel the air
and inject the mixture.
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Equipment Care
Be sure to inventory your set prior to surgery. All instruments for a case are assigned to the senior student
scrubbing on that case, and that student is financially responsible for their return to Central Supply. Report
any discrepancy to the O.R. technician at the start of the surgery.
The kick bucket, not the instrument tray, should be used as a receptacle for bloody sponges and body tissues
being discarded.
Dirty instruments should not be placed on clean instruments on the Mayo tray, or on the drape. Try to
maintain an orderly tray; this is the assistant's responsibility if one is present.
Instruments are to be returned to Central Supply. They need not be washed if returned immediately, but all
sharps should be removed and placed in proper receptacle (blades, sponge needles, etc., in "sharps" container
in each room, re-usable surgical needles washed and returned to counter top next to cold tray). If Central
Supply is closed, instruments must be washed and dried so that they will not rust. Suction hose should be
flushed. These instruments should be kept in the locked room behind the nurse‟s station until the earliest time
the student can return the instruments to Central Supply and wait while they are inventoried and checked in.
Cautery handles and suction hoses and tips should be returned to Central Supply with instrument sets.
REMEMBER! Anything reusable will have to go back to Central Supply to be re-sterilized.
All power drills are to be wiped off (do not immerse in water) and oiled before re-sterilization; inform O.R.
technician upon completion of case and she/he will oil the drill.
Post Surgical Procedures:
The person who removes the endotracheal tube will return it to the anesthesia recovery room (C108A), clean
it with the brushes provided there, and place it in the designated container to soak. Ditto for esophageal
stethoscopes.
Drapes should be placed immediately in the laundry hamper not on the floor. They do not need to be rinsed
or soaked; however, all large blood clots are to be removed. Keep tissue, feces and other trash out of the
laundry.
The student assisting the surgeon must take tissue samples from the O.R. when they complete the surgery or
the O.R. staff will dispose of them. Tissues designated for histopathology must be delivered to the cooler in
Medical Records by the student assistant as soon as possible with the completed Diagnostic Lab form. Also,
be sure they are labeled properly with the name, client, date, surgeon, location of tissue sample and case
number.
Upon completion of surgery outside regular hours1

Be sure to turn off oxygen and vacuum supply at anesthesia unit and disconnect all lines from ceiling
drop cords.

Wash top of O.R. table with disinfectant, clean other equipment and put it back where it belongs (Vtroughs, on counter, leg ties on table, etc).
100

Wash and dry instruments and have the staff person on the case lock them in the instrument room.
Also, any unused still sterile instruments or packs from SAS or Central Supply need to be locked up as
well.

Be sure charge sheet for all suture, stockinette, Vetrap, suction bags, etc., is filled out
completely. Charge sheets are kept in pocket on wall in all O.R. rooms.
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VI: SUPPORT SERVICES
A. Animal Behavior Counseling
The CSU-VTH does not offer clinical services at this time.
B. Argus Institute Support Service
The Argus Institute staff is here to support clients during Emergencies, Surgery updates, Delivery of
Diagnosis, Treatment Decision-making, Euthanasia Decision-making, Grief Due to Unexpected Death or
Euthanasia, and for Counseling.
If clients require emotional support, there are several steps you can take:

Listen to them as best you can. Most people want to be reassured that they are not "crazy" for feeling
grief at the loss, or the potential loss, of a pet. Saying something like, "Pepper is/was a member of
your family. I can understand why you're feeling sad," can help calm them down.

Tell them about the Argus Institute services and suggest they call us during business hours Monday
through Friday at 297-1242, or have us paged. A staff member is usually available each day from 9:00
a.m. to 5:00 p.m. If their call comes in after regular business hours, or if they are hesitant to talk to us
at the time of your referral, you can suggest that we will call them. Be sure to get a daytime telephone
number. We realize some clients will prefer to have us contact them at home late in the day, but we
need to contact them during the day in order to set up a telephone appointment.

After business hours, if you feel that a client needs to talk with one of us immediately, please do not
give the client our home numbers. Tell them you will try to contact one of us and have us call them
back. If you don't reach a staff member, please call the client back yourself to tell them that it may be
several hours or even until the next day before we get back to them. This way they won't be waiting
by the telephone.
Gail Bishop
Erin Allen
207-1550
482-2771
(Please DO NOT give these numbers to clients)

In the event of an extreme emergency (e.g. suicidal client or even homicidal), and during regular work
hours, keep the person on the telephone, or in a room if they are in the hospital and tell a co-worker to
reach one of us on another line, or page us at #242. If we are not available in the hospital or at home,
the co-worker should contact one or all of the following for help:
All Emergencies (from CSU-VTH)
Fort Collins Police
8- 911
221-6540
102
CSU Police
Larimer County Mental Health (24 hrs.)
491-6425
221-2114
Try to get the person's location (address) and telephone number so someone can attempt to help. If they are
from another town, that town's authorities should be notified. If the person hangs up on you before you can
do this, don't panic. You can only help a person in crisis if they allow you to help. This situation is extremely
rare. If it should happen while you are on duty, however, you must contact an Argus Institute staff member
no later than the following day so all involved in the case can be debriefed and the facts put in written form.
We are a support program for you as well as for clients. If you've had a particularly difficult emotional case,
please contact us so we can help you sort it out. Also, remember that our brochures, business cards, and
condolence cards are available in the Argus Institute clinic office (Room 109 in the new exam room wing)
and on the Argus Institute shelf in the short hallway between exam rooms (Derm Alley in the original exam
room hallway).
C. Central Supply Procedures
Inpatients Central Supply Hours
Monday thru Friday 7:00 A.M. - 5:00 P.M. After-hours, one person is on call. The phone number is listed by
Central Supply‟s window. If no one answers, use the pager.
General
All bandage material and IV catheters will be dispensed by Central Supply. A few inexpensive general use
items are stocked in small animal treatment areas. If you need bandage material or IV catheters and/or
services you must bring the embossing card, patient case numbers or the proper “H” account number.
Bandage Material
When you obtain a roll of tape, elastikon, kling, or any type of bandage material for a patient and you do not
use the entire roll, the patient has paid for it and a half used roll cannot be returned for refund. If the patient is
an inpatient, place the unused roll in its box in the treatment rooms to be used later. If it is an outpatient, send
the unused roll home with the client -- after all, they have paid for the item.
Outpatients
When an animal returns for bandaging and will be discharged when you have finished, please tell Central
Supply that the charges are on an outpatient and should be entered at once into computer. Do not send the
client to the Discharge Center to pay until you have returned the bandage or cast kit to central supply and told
us the client is going home. We must enter the charges right away.
Instruments
General - All instrument packs, clippers, twitches; everything is kept in Central Supply. To obtain a given
item, you should come to Central Supply and sign out the needed items. The item must be returned to Central
Supply as soon as you have finished using it. Do not give the equipment to someone else to return--it is in
your name and you are responsible for the equipment.
103
Surgery
When you are in surgery, your instrument sets will be picked up for you in the morning by the surgery tech.
When the surgery is over, it your responsibility to return the set of surgery instruments used to the Central
Supply check-in window and wait until the instrument packs have been checked in. It is easier for you to
return to the surgery area at that moment in time and find the lost instrument, than for the people in Central
Supply to try to find the lost item hours later. Do not leave a set of instruments or any item you are checking
in at Central without telling the people who work there who checked the item out! You do not have to clean
the instrument sets when you return them – just remove all sharps and wait while we check your sets.
After hours if Central Supply is closed and you have a set of instruments to check in, you must clean and dry
the instruments and place them in a safe place. Do not leave instruments soaking overnight, they will rust.
Return the clean and dry instruments the next morning as soon as you arrive at the hospital.
When anything (i.e. dog combs, brushes, suture scissors, stomach tubes, clippers, etc.) is checked out of
Central Supply, it is the student‟s responsibility to return the item. Please return checked out items as soon as
you are finished with them. Do not pass them on to another student. Do not expect anyone else to return your
equipment. If an item checked out in your name is lost, you will be billed the cost of replacing that item.
Please check with Central Supply before going on vacation and make sure you have nothing checked out.
When you are on the student labs (S1, S2, S3), all of the students in that lab for one week are responsible for
the instruments checked out to the lab for that week. Central Supply counts the number of instruments unique
to the lab each day, the students sign for the instruments every morning, and all of the students are responsible
for seeing that everything is returned. If an instrument is lost, the cost of the instrument will be divided by the
number of people in the lab for that week and everyone will pay for the lost instrument.
Clipper blades (#40) cannot be checked out by students. You may make a $10 deposit at the beginning of the
semester in the Hospital Director's office and receive a clipper blade.
Prior to the close of each semester, each graduating senior who has checked out a blade will return it to the
Director's Office. The deposit will be returned to you if your clipper blades have all of the teeth present. Dull
blades will be replaced (exchanged) by Central Supply during the semester if you have all of the teeth in the
blade.
After-Hours:
Central Supply will be locked at all times nights, weekends and holidays.
Small Animal
Room B109 is the small animal emergency room after-hours. There are instrument sets, bandage material and
IV catheters locked in cabinets for use after-hours. Make sure you write down the client‟s name, animal case
number and supplies used on the slips provided in B109. Central personnel will charge the client. Lock the
cart when your are finished.
Large Animal
There is a special crash cart made for large animal instruments sets and a cart for bandage material and IV
catheters. These carts are in the barn. Any instruments used from the crash carts are to be cleaned, dried and
returned to the crash cart. Any bandage materials or catheters used are to be charged to the client. Please
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write down the client‟s name, case # and what you use on the slips found in the drawers of the crash carts.
Make sure that carts are locked when you are finished.
Crash Cart Keys
The keys for both B109 and the LA crash carts are kept on a checkout clipboard in CCU. When using these
keys, you must sign for the keys and put down the client name and case #. Please return the keys at once
when you are finished. Crash cart keys are only available when Central Supply is closed.
Laundry
Dog Blankets - There are blankets kept in CCU for CCU's use. Try to use only one blanket per animal so
there will be enough to go around. Blankets for use in the wards are outside of laundry on a cart and are to be
used for ward dogs only. Return dirty blankets to the laundry to be washed. Do not let dirty blankets pile up!
Do not throw the blankets away. If you do not return the dirty blankets to us, we can not wash them and
therefore you will have no clean blankets.
Please do not put sharps, trash or body parts in the laundry.
Please return all dirty and wet towels to laundry so we can wash them.
Scrub suits will not be checked out to students. Students provide their own scrubs. Always keep a set of
scrubs in your locker, even when you are not on surgery.
There are no coveralls available for student use. You must provide your own.
There are no blue or green smocks for student use. You must provide your own. White coats are for
clinicians use only!
We do not wash student laundry.
D. Clinical Pathology Services
Laboratory Submissions
The laboratory is routinely open from 8:00 a.m. to 4:30 p.m. every weekday. Samples are to be submitted to
the Clinical Pathology Laboratory at the desk in room C102. All tubes are to be labeled with the client's
name, patient‟s ID number (or name if no case number assigned) and the date; include the source, as bone
marrow, serum, abdominal fluid, etc. if other than peripheral blood. Be sure to include time of sample if there
are multiple samples in the same day.
Type of sample necessary for each test is outlined in "Clinical Laboratory Test Sample Requirements and
Information" in the formulary and posted on the bulletin board outside room C102. The lab will freeze excess
serum samples for about 2 months at no additional charge. Samples submitted for storage only are assessed a
handling fee. These samples will be held for up to three months, after which time they will be discarded.
Longer storage of samples is the responsibility of the clinician.
Results for samples submitted for testing by 8:30 a.m. can expect by 9:30 a.m., particularly if the patient is
pre-op. Turn-around-time for other routine submissions is approximately 2 hours. Samples requiring clotting
should be submitted by 3:30 weekdays to guarantee results by 5 p.m. Other samples should be submitted by 4
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p.m.
Specimens, including research, submitted after 4:00 p.m. (3:30 p.m. for automated chemistry requests)
weekdays, and marked ASAP or STAT, will be charged as emergency requests and will be completed by the
emergency technician on duty. All other specimens will be held until the next business day.
STATs and ASAPs:
STAT is an abbreviation of the Latin word STATIM and means immediately. WHEN STAT WORK IS
SUBMITTED, OTHER WORK IS STOPPED AND THE STAT WORK IS PERFORMED. BECAUSE
OF THIS, ALL STAT WORK SHOULD BE LIMITED TO EMERGENCY (LIFE OR DEATH)
SITUATIONS ONLY.
The ASAP (as soon as possible) notation may be used in non-"life or death" situations where lab results are
needed sooner than usual (emergency surgery, chemotherapy, etc). Please inform the receptionist or
technologist any time work is requested "STAT" or "ASAP" so that the work can be completed as needed.
Night/Weekend Emergency Technician (ET) Service
This service provides technical support in Clinical Pathology during the hours:
Monday-Friday
Saturday-Sunday
Holidays
4:30 p.m. to 9:30 p.m.
8:00 a.m. to 8:00 p.m.
8:00 a.m. to 4:00 p.m. unless posted otherwise
For CBC's taken after laboratory hours, it is preferred that at least one good smear be made, labeled and left
with the request. The properly labeled blood sample should be placed in the student lab refrigerator. Slides
should not be refrigerated. Samples taken at night for chemistries must be allowed to clot, centrifuged, the
serum removed and placed in an appropriately labeled test tube and refrigerated. Paperwork is placed in the
basket on top of the refrigerator in the student lab.
Please note that heavy clinical pathology workload, such as that involved with starting up the lab each
morning, may delay reporting of results.
Specimens and requests must be in the lab 30 minutes before the end of the evening shift to guarantee
avoiding a $32.00 surcharge. The surcharge applies if specimens are received after the cut off time and the
ET is required to stay beyond scheduled lab times.
The emergency technician (ET) on duty should be contacted in the hospital by beeper and at home by
telephone, and beeper if necessary. The name, beeper and phone number of the ET on duty is posted at the
small animal desk and on the duty sheets.
This service should satisfy the vast majority of emergency laboratory needs at night and on weekends. There
are several options for laboratory tests after these hours which should be utilized in the following order:

Decisions for performing laboratory tests very late at night should involve critical review of their
necessity. In some cases, a satisfactory approach involves collection of blood tubes for next-day analysis
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followed by institution of symptomatic therapy. It is desirable that students receive some exposure to this
approach.

Utilize students to perform simple laboratory procedures on equipment available in the student laboratory.
See “Student Lab-B103” below. Note: only VTH staff, not students, trained by Clinical Pathology
personnel may operate the Blood Gas Analyzer.

If it can be anticipated that certain simple tests will require monitoring through the night, a student should
be assigned to this task. The student should be sent to the laboratory in advance. Laboratory personnel
will aid the student in reviewing the particular procedure.

As a last resort, in emergencies where laboratory testing will have an immediate effect on the outcome of
a case, the on-call technician may be called back after the indicated hours until 6:30 a.m. A $49.00 call
back fee will be assessed to each client using this service. Calls received after 6:30 a.m. will be referred
to that day's scheduled staff. Call the Clinical Pathology Coordinator if there is a "life and death"
emergency that will not wait until the lab opens at 8:00 a.m.

Tests available on an emergency basis are limited to those indicated on the request forms in addition to
fluid analyses. Refer to the fee schedule for current prices but note that emergency requests run up to 50%
higher than routine requests.
Request Forms

Fill out all blanks on the form requesting information. These include date, clinician, student, history and
treatment.

Use the patient‟s blue card; check to see if it printed on copies of multi-copy forms. If the card is not
available, hand write case #, if available, owner‟s last name, species and patient‟s name on the request
form.

The Automated Chemistry/Hematology request form is used when requesting biochemical tests, profiles,
CBCs, Reticulocyte counts or platelet counts.

The Bench/Special Chemistry request form is for urinalysis, coagulation, blood gases, and miscellaneous
tests that are not available on the Automated Chemistry/Hematology form.

Request forms must be submitted for all tests requested.
Results
All results are placed in the window and are for clinician, staff or student use. Medical Records will receive a
copy of all lab results. Additional copies of completed Hematology, Chemistry, and Cytology results may be
obtained as follows from the VTH Home Page:





Click on “VTH Patient Information”
Enter case number and/or other known identifying information
Click on appropriate invoice related to date of data desired.
Click on any blue, underlined item indicating results that may be viewed and/or printed.
Click on the printer icon; results will print at the default printer for that terminal.
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Alternatively, CBC and Chemistry results, whether complete or not, may be viewed and/or printed (up to 4
sets on one page) off the Chimera VTH menu screen as follows:









Log In to Chimera with user name and password.
Type V for Veterinary Teaching Hospital
Type D for “Lookups”
Type F for Clin Path and Radiology results
Select Find Animal from the menu across the top
Type in case number or owner last name and press Esc key
If appropriate patient, press the F2 key
Select Hematology, Chemistry, or Radiology for desired results.
Select Print. Up to 4 sets of most recent Clinical Pathology results are printed on one page.
If older results are desired, press the Enter key until desired date is indicated on the screen. Copies of all
work on file in the lab and results may be obtained upon request. No laboratory copies are to leave the lab for
any reason.
Send outs
All laboratory samples to be mailed out will be processed through the Clin Path Lab. Proper forms and
instructions for handling samples may be obtained in Clin Path. There will be a VTH handling fee ($13.50)
for each sample. Shipping costs may vary from $18.00 to $34.00 depending on packaging (dry ice, etc.).
Prices are subject to change without notice. Samples are shipped Monday through Thursday and must be in
the lab by 11:00 a.m. in order to be processed the same day. Charges are assessed at the time samples are
submitted for processing. Results are received by Clinical Pathology and copies are placed in the window or
in the clinician‟s mailbox in addition to medical records. Please note that Clinical Pathology will not send
out samples for outside veterinarians.
Research Support Policy
Investigators must obtain approval via a "Facilities and Support Statement" for proposed research projects.
Arrangements for times of sample submission and methods for sample handling must be made for funded
projects with the laboratory supervisor ≥5 days prior to the start of the project. Reduced research prices are
available for batched (≥5) research samples meeting the above criteria. An H-account number must be
provided at the time of sample submission to receive research rates and are obtained through the Hospital
Director‟s Office. Please note that “STAT or ASAP” submissions are not eligible for research prices. The use
of laboratory equipment by non-laboratory personnel is prohibited, with the exception of the designated
equipment in the student lab. Appendix: Clinical_Pathology_Research_Support
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Cytology
Slides submitted for cytology are to be labeled with a “Sharpie”
with the patient‟s ID, source and date of the sample. Avoid
exposure of samples to formalin fumes.
Case #
Source
Date
specimen
You are encouraged to submit cytologic preparations before noon.
Samples must be submitted by 2:00 p.m. to guarantee results by
5 p.m. There may be occasions when samples submitted after
2:00 p.m. will be completed the next day. Requests should be
marked STAT, ASAP or routine for prioritization.
Body fluid analysis data, including a preliminary microscopic evaluation, is provided by an emergency
technician on samples submitted during emergency hours. Such reports are reviewed by a pathologist the
following business day. Clinicians are welcome to review these results prior to being signed out by the
clinical pathologist.
Availability of clinical pathologists in the clinical laboratory area
A clinical pathologist or senior resident is almost always available from 9 a.m. to noon and 1-5 p.m.
weekdays. Students and clinicians are welcome to review officially submitted slides with the clinical
pathologist on duty.
All cytology samples taken from patients should be submitted to the clinical pathology laboratory for
appropriate evaluation and to insure that a cytology report is generated and placed in the medical record. It is
inappropriate for these samples to be interpreted by clinicians or students, and then brought to the lab for a
second opinion by the clinical pathologist. This leads to a hurried evaluation, lack of a report in the medical
record, and loss of revenue by the VTH. Appendix: Clinical_Pathology_Research_Support
Verification of suspect laboratory results
Clinicians are part of a long chain of events in the laboratory quality control process. It is appropriate to
question the accuracy of results and sequential changes. It is inappropriate to frequently question results that
do not support a preconceived clinical diagnosis. Errors in sample collection are the responsibility of the
clinician. True laboratory errors will be remedied at the lab‟s expense.
The medical technologists and clinical pathologists have a network of mechanisms for verifying results prior
to reporting. The automated hematology and chemistry systems employ the most extensive control and
cross-checking methods available. Significantly abnormal hematology results are reported as “Pending Path
Review” until a pathologist reviews the data. In addition, samples are saved in case there is further need for
verification.
The laboratory will respond to prompt questions about results and specific concerns involving data may be
presented to the medical technologist or microscopy to the clinical pathologist. The clinician may present the
nature of any concern to the laboratory coordinator. Laboratory personnel will work together to decide the
mechanism for resolving the concern. An appropriate response will be returned to the clinician.Additional
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Student Experience in Microscopy and Laboratory Techniques:
Current Microscopy Case Material
Cytologic and hematologic glass slides from clinic cases are available for review by students assigned to those
cases. They are kept in cardboard mats in daily racks on the wall in room C102A, the slide reading room.
Slides are not to be removed from the room and are to be returned to the wall rack after they are reviewed.
Student Lab, Room B103
Students may utilize this room for practicing procedures available. These include Unopette WBC and platelet
counting, microhematocrit centrifugation, hematocrit determination, plasma protein by refractometry,
urinalysis and glass slide staining. Procedures performed as part of clinical patient care should be done in
tandem with the clinical pathology laboratory. The student lab is not to be used to perform "free" laboratory
tests. Please clean oil of microscope objectives and turn off the microscope and pointer after use.
E. Computer Procedures on VTH Medical Records/Financial System
The following sections deal with two different computer accesses: text sessions and Web pages. The first
portion describes access features and procedures on text terminals. These are single display terminals, Xstations, and telnet sessions available on PCs. While within text sessions, operation of the device does not use
a mouse.)
Clinicians, residents, interns, and students can check the status of computer invoices and medical information
on the VTH hospital system without assistance of the staff. This process involves locating a computer
terminal or opening a telnet session on an X-station or a PC; logging in to the computer, choosing the
appropriate actions on program menus, and responding to program prompts.
Available Terminal, PC, and Printer Locations:
Terminals available for general use are in the small animal examination room hallway, in the hallway behind
the Pharmacy, various wards, barn and isolation areas. The Computer Lab in room A224 of the VTH has a
number of terminals. This and the Web sessions described below are available by wireless connection in the
facility.
Text session notes
Important Keys:
Some terminal keys have special meaning in the VTH system. Some reference is made to alternate keys
which might be necessary for other keyboards.

Accept-ESC (labeled Esc on most other keyboards) is located in the upper left corner.

Cancel (control-c)

Enter, Tab, Down and Up arrow keys will move the screen cursor from field to field. (right and left
arrow keys only move the cursor one space at a time).

F1, F2, F3, F4 have special use in the VTH system. When they are called for, the screen usually
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describes the use of the appropriate F key. Generally, F1 allows for looking up codes for clinicians,
species, etc; F2 causes movement to the next screen in a process; F3 displays help. On some
keyboards it is necessary to use alternatives to these keys. Unless described otherwise the
replacements are:
o
o
o
o
F1 - control - v
F2 - control - n
F3 - control - w
F4 - control - i

Some laboratory result displays use controls t, n, u, i, respectively for F1, F2, F3, F4.

Caps lock should not be on in VTH system use.
Logging in

If problems are encountered in logging in, call the Help Desk at 74357 for assistance.

Type your username (usually your first initial and the first seven characters of your last name in lower
case with no spaces, For example, Mary Smith uses msmith, while Gerry Anderson uses ganderso at
the Login prompt.

Type your password

If no prompt is visible press the Return key. In some instances, control-d or control-q followed by the
Return key are necessary.

Type your password at the Password prompt.
Ring Menus

From this point, you will operate with ring menus. Make selections by:

highlighting the desired option (use the space bar or the arrow keys) and then press Enter, or typing
the capital letter in the option.

Print and View options are available in several places.

Print will print your document to Medical Records 104 printer.

When Viewing, press Enter at the ":" prompt to see the next screen of information, or "q" and Enter
to quit viewing at any time.
Case Info is available on several menus: All user, Access, Clinician, VTH General Access: {see also Case
Information (Results)}

Provides a complete listing of client and animal information and allows a blue card or patient history
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to be created for the animal. (This option is the same as the Animal option under Misc.)

The Case info option will require a Find on the case number or client‟s last name. Once the find is
complete, press F2 to get to the next screen.

At this point, you may print a new Blue card. Press Enter and the card will automatically print on the
card embossing machine in the Small Animal Reception area. (If the animal has never been here
before, the Blank card option under Misc must be used.)

If the Patient history option is selected you will be prompted for a comment. You may enter a
comment and press Enter or just press Enter. If you do not press Enter, nothing will happen. BE
PATIENT(!), it may take several seconds for the computer to get the information together. You may
then Print or View this report when it is completed.
Invoice
Choose Misc from the first menu and choose the option Invoice from the next menu. Choose Find to find a
specific invoice. The Find may be done by case number, invoice number, client account number, or by owner
name. If you search by owner name, keep in mind that the more specific the information you give, the
quicker your search will be. For example, when doing a search on John Doe, enter the last and first names in
the appropriate fields and press accept to start the search. If the first letter is all that's known of the first
name, type that letter with an '*' in the first name field in order to help the computer narrow your choices.
Once the computer has brought up the individuals matching your search parameters, use the page up and
down keys, and up and down arrow keys to view look through the invoices. When you've found the one
you want to view, press F2 (Next Screen).
You now have the option of viewing the invoice the client receives or an internal statement. The Client
option is an invoice in the form the Business Office would produce or mail. The Internal option will produce
an invoice with internal hospital coding and without client payment instructions. The invoice will take
several seconds to create. You may then Print or View the invoice as described in the Ring Menus section.
Should any problems arise in the above procedure or any of the following, the F3 (Help) button, should be
able to provide additional information.
Lab Results
{see also Case Information (Results)}
Laboratory results are also available to VTH1 Server Users. Upon logging in select V for Veterinary
Teaching Hospital; D for Lookups; and A for all user access. Clinicians also have Lab access through the B
for Clinician choice) Some VTH service areas (e.g. Anesthesia, Food Animal, and Equine Medicine) have
access to laboratory results from the Lab menu choice in their regular programs. {also see Case Information
(Results)}
Query
The Med Search option allows an individual to find medical or imaging information for a specific animal.
Searches are now done by the Medical Records department. A search request form needs to be filled out
and returned to Medical Records. At some point in the future it will be possible for simple searches (eg. all
dogs with one problem), to be run by students, clinicians or house officers.
Misc
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
The Client-search option allows current information on clients and animals to be accessed.

The Printer option allows the individual to choose another printer.

The Ref-vet function allows the individual to call up the address and phone number for referring
veterinarians who are in the system. Additions and corrections are
done by the Reception
area...

The Animal option includes both Patient history and Blue card and is accessed as described in Case
info above.

Herd can be used to view herd and client information.

The Blank-card option can be used to print a blue card for an animal that has never been to the VTH
and arrives after the reception staff has left for the night or before they arrive in the morning. The
individual will have to manually enter the information into the fields.
Case Information (Results)
This option parallels some of the capability that some of you have used under the Student or Clinician Menus.
It also adds capability in result retrieval. This menu, “Case Information (Results)”, is accessible under
“Lookups” on the Veterinary Teaching Hospital menu or “Case Information Results”. It includes three kinds
of requests/results: Hematology; chemistry from mid October, 1997, and radiology reports (text and
conclusions) since early May, 1997 and conclusions for all others.
Patient Appointments and Schedule
These options allow viewing patient appointments by service area or groups of reception areas. Through ring
menu options you can view schedules of client animals. Use of arrow and function keys described on screen
allow you to see the details (e.g. clinician, complaint, and referring veterinarian.)
2. VetPoint Users Guide
(Updated February 24, 2009)
VetPoint Access
VetPoint is currently available on the CSU VMC Citrix Server (VMC ICA Login). You can access VetPoint
from either CSU VTH computers or from outside computers including your home computer if you are able to
log into Citrix. In order log into Citrix, the computer you are using must have the Citrix ICA Client installed.
If you are accessing VetPoint from a wireless computer or from a home computer you need to also have the
VPN (Virtual Private Networking) utility installed and running.
 Accessing VetPoint from your Personal Computer:
o Installing Citrix ICA Client: Download the Citrix software by going to the VTH HomePage
and then linking to the Remote Access to VTH Apps site. From there, click on the line that
says “Click here for Win-200, Win-XP (use default settings)” link. Save the program to
your computer and then run it to install the Citrix ICA client on your computer.
113
o Installing VPN: Download the VPN utility by going to the VTH HomePage, then link to the
ACNS site and from their scroll down to the section on Connecting to the CSU Network.
Link to VPN (Virtual Private Networking) and download the most current VPN software and
save to your computer. Then run the VPN program to install it on your computer.
Alternatively, you can go directly to the VPN download page at
(http://www.acns.colostate.edu/?page=vpn).
Once you have installed Citrix and VPN (if needed) you can get to VetPoint by going to the VTH HomePage
(www.vth.colostate.edu) and linking to VMC ICA Login. From there, open VetPoint by double clicking the
VetPoint icon
. If you are using a wireless computer, make sure that VPN is connected.
VetPoint Main Page
The VetPoint Main Page is developed to allow you,
the user,
to select the items you want to see and use. The
VetPoint
Main Page currently has a VetPoint Menu on the left
edge, a
tab for the Home page, and a tab for Calendars. More
items
will be developed in the future.
 VetPoint Menu: This menu on the left allows
you to select the window options that you
would like to use for your personal VetPoint
setup.
o
The thumbtack in the top right hand
corner of the VetPoint Menu is the
menu AutoHide button. If you would
like more room to view the main pages
on the screen you can click on this
button and the VetPoint Menu will slide
to the left side.
o To get the menu to slide back, just move your mouse over the VetPoint Menu tab on the left
and it will slide back.
o To restore the VetPoint Menu so that it is always fully visible, click on the
icon.
o In a future revision of VetPoint, you will be able to select a default service area so that the
Patient Appointment and Recent Patients list will open showing only the cases in that specific
service area.

Searches: The Medical Search function allows for very
extensive searches of medical records based on patient, visit,
service area, procedures, and diagnostic criteria. Trying some
simple searches on your own is the best way to learn to use this.

Preferences:
o Default Service Area: There is a drop down list of
service areas from which you can select the service area
that you are currently working in. By selecting a
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default service area, only patients from that service area will show up on your patient lists
when you open VetPoint.

VetPoint Home: The default VetPoint Home page has three open windows; Patient Appointments,
Action Items, and Web Browser. Other windows can be selected and opened from the VetPoint Menu
on the left. You can open, close, move, and resize the windows that you want on your VetPoint Home
page.
o To close a window, click on the X in the top right corner of the window.
o To resize a window, click and drag the window‟s top menu bar.
o To open a new window, click on the item in the VetPoint Menu.
Your last used settings will be saved and VetPoint will show that view the next time you open it. If
you ever want to go back to the default settings, you can just click on the Reset Default Layout on the
VetPoint Menu bar.
o Patient Search: There is a very simple patient search at the top of the VetPoint Main Page.
Search criteria includes Case Number, Invoice Number, Owner Last name, Owner First Name,
Animal Name, and Year.
 Input your search criteria
 Click on “GO”
 You can use an * as a wild card either at the start or the end of a name or word.
 You will get a list of cases that match your search criteria.
 If only one case matches your criteria, VetPoint will automatically open that specific
patient record.
 Patient Name will be added as a searchable criterion in the next revision of VetPoint.
o Patient Appointments: This window will list all of the patient appointments scheduled for
that day and appointments that are scheduled for the future (Preadmit). When opened, the list
initially includes all VTH appointments for all service areas. You can readily narrow down the
list by sorting from any of the columns or by selecting your current service area as the
DEFAULT SERVICE AREA on the side menu.

The funnel tool at the top right of the column opens a drop down menu that allows
you to select a specific criteria in the column. For example, you could select a specific
service area from the service column and only see the appointments for that service.
You could also select by status, date, clinician, species, etc.
 If you click on the name heading at the top of the column, it will sort the list by
ascending or descending order for the column.
o Recent Patients: While the patient appointment list contains the appointments for the day and
future scheduled appointments, the Recent Patients list contains all cases that are currently
active, or were active within the last 10 days, and preadmits. This page is particularly useful if
you want to access hospitalized patients or patients that were here recently but are now
checked out. By selecting your service area and then clicking on the top of the status column
you can quickly organize your patients for the area that are currently active. You can also
select your DEFAULT SERVICE AREA on the side menu so that only cases for that service
are displayed on your list when you initially open VetPoint.
o Action Items: The Action Items window contains the current actions assigned to the person
logged into the VetPoint portal. The default Action Items list includes, History Reports,
Physical Exam Reports, Prescriptions, Surgery Reports, Discharge Summaries, and Referring
Veterinarian Letters. This area will be developed to inform you of items related to a medical
115
record that need your attention or completion. Currently, there nothing in the Action Items
section that pertains to students so you can remove this from your main page if you like.

A Plus Sign + indicates that you have Action Items to complete. When you complete
your actions, the Plus Sign + disappears and the action is removed from your list the
next time you log in (or if you close the window and re-open it).

In the records process, students, staff, or clinicians will fill in record forms. Drafts can
be saved at any time. Once a student or staff has completed a form they can submit it
for approval by the clinician or house officer. The medical record can not be finalized
and closed until all medical record forms are approved by a DVM with their electronic
approval or signature. When a form is approved, it is time stamped and made read only
so that no further editing can be done.
Patient Records
To access a patient record you simply click on the case in the patient list. This will open the patient record
window with the Patient Menu and Patient Overview displayed. Multiple patient records can be opened at
one time and will have individual tabs that allow you to move between patient records.

Patient Menu: The patient menu allows you to select aspects of a patient record to work with.
o Currently available pages include:
 Fee Estimate – Edit
 Fee Estimate – Printable View
o You can also use the AutoHide function for the Patient Menu to get more room on your screen
for the patient record.
116



o The
and
arrows on the Patient Menu allow you to expand or collapse a specific group in
the menu.
Attending Clinician: You can select and change the attending clinician from either the Patient Info in
the patient menu or from the patient overview by selecting the appropriate clinician in the box.
Patient Overview: The patient overview window gives the basic information about the case including
signalment, owner, and referring veterinarian. It also lists the previous visits with the specific
complaint and provides basic financial information including the financial estimate and current
charges. In the future, there will be the ability to link an image to the place where the sex status image
is located so that you can include a picture of the patient on the patient overview page.
Current Visit: The current visit tab provides access to the medical records for the active invoice.
o History Form: This standardized history form is available for all service areas. The printable
version is initially viewed by default. By clicking on the edit tab you get access to a form with
multiple input fields. Drafts can be saved at any time. Once a student or staff member
completes the history, they should submit it for approval by a DVM (clinician or house officer)
who then will approve the history with a time stamped electronic signature. Once approved,
the form can not be edited any further.
 Additional history forms can be opened if additional information becomes available by
clicking on the add record tab.
 Note that you can also click on the Prior Visits tab to open the history up into two
windows, one allowing you to view prior histories and the other allowing you to input
information to the current history. You can also copy (ctrl C) and paste (ctrl V)
information from prior histories to the current history.
o Rx Tab: Currently contains previous prescriptions for the patient. In the future will provide an
electronic pharmacy prescription form.
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o Weight Tab: Currently opens a table of previously recorded body weights including a table of
weights that have been entered on paper physical exams and weights that have been entered
electronically. In the future this will phase to only electronic entries.
o Physical Exam: A General physical exam form is available for all services. Many specialty
physical exam forms are available and a few more are in development. These will be released
as they become available. A general physical exam must be done at least once for a patient
before any specialty exams can be entered.
o SOAPs: Currently, electronic SOAPs are only available for equine and livestock services.
This will be developed for all sections in the future.
o Surgery Reports: Currently, electronic surgery reports are only available for equine and
livestock services. This will be developed for all sections in the future. The electronic surgery
reports will have the ability to create standardized surgical procedures that can be pasted and
edited.
o Diagnostics: The diagnostics tab will display a table of all of the diagnostics performed on the
patient and recorded at CSU. This will include tests for the current visit as well as all previous
visits.
o Attachments: The attachments tab will display all of the invoiced items, including image
attachments, diagnostic tests, and referring veterinarian letter for the invoice selected. You can
also view all of the procedures recorded for the visit. You can upload image files for storage
with the record from this page. In the future, there will be a separate area that will provide
better storage and organization of file attachments including images, videos, scanned PDFs,
sound files, etc.
o Communications:
 Misc.: This links to the current electronic communication log. Click the edit button to
open the form with input fields.
 Ref Vet Letters: This will link you to the current electronic Ref Vet Letter editor.
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


RTGs: This will link you to the current electronic RTG forms for the various small
animal services.
Discharge Summary: This links to the current version of the combined electronic
medical and discharge summaries used for equine, livestock, and dermatology services.
This electronic form contains all of the fields required for a complete medical summary
and discharge instructions without having to repeat this information in more than one
place. Further, the information in these forms can be automatically imported into the
Ref Vet Letter. In the future, all service areas will go to a system similar to this so that
medical summary information only needs to be completed once. Also, the discharge
summary will be moved up to have a tab of its own for the patient.
Prior Visits: Clicking on the Prior Visits tab will open up all of the previous electronic medical
records for the patient. You can access all of the read only records from previous visits. Records can
be selected either by date of visit or by numerical order.
E. DIAGNOSTIC IMAGING
SENIOR ROTATION SCHEDULE
Section Chief ................................................................................................................................ Dr. R. D. Park
Faculty.............................................. Drs. S. L. Kraft, A. Marolf,D. Gibbons, E Randall, A. Valdes-Martinez
Residents ............................................................................ H. Thode, D. Gall, M. Barrett-Frisibie, K. Selberg
Chief Technologist ....................................................................................................................... J. Van Cleave
Technologist ................................................................................................. J. Specketer , L. Jensen, E Thorne
Office Supervisor.................................................................................................................................. S. Brown
Office Assistant .............................................................................................................................. J. Dideriksen
Radiology Assistant .........................................................................................................................S. Eggleston
Nuclear Medicine ................................................................................................................................. R. Vocke
Computed Tomography................................................................................................................. B. Arceneaux
Magnetic Resonance Imaging ............................................................................................................. J. Stewart
Ultrasound Assistant........................................................................................................................... R. Parham
PREREQUISITE - REVIEW VM625 MINICOURSE , VM726 and VM278 Imaging
Interpretation I and II
Recommended Textbooks:
Recommended Textbooks:
Daily Schedule
8:00 a.m. to 9:00 a.m.
9:00 a.m. to 11:00 a.m.
11:00 a.m. to 5:00 p.m.
Techniques of Veterinary Radiography
Textbook of Veterinary Diagnostic Radiology
Ed. J. P. Morgan
Ed. D. Thrall
........................................................... Make and interpret radiographic studies
.................................................................................................. Imaging rounds
. ......................... Make and interpret radiographic or ultrasonographic studies
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PURPOSE OF THE ROTATION
1. To review basic principles of imaging technique (refer to previous class notes, books, and handouts.)
2. To insure a working knowledge of imaging equipment
3. To become adept in animal positioning for radiographic examinations. You will be asked to make
diagnostic studies on your own.
4. To critique technical factors on finished radiographs by discussion with technologists and radiologists.
5. To become more proficient at radiographic and sonographic interpretation.
6. To become familiar with Nuclear Medicine Scintigraphy.
7. To perform a routine radiographic examination of the area of your choice using an Xray machine
appropriate for veterinary practice. The written critique form (provided in this handout) should be filled out.
8. To become familiar with sonographic examination technique.
YOU ARE EXPECTED TO:
1. Report to the radiology section wearing your film badge promptly at 8:00 a.m. to the assigned Technologist.
You will either help with scheduled radiographic examinations, attend technical instruction, or review cases
from the senior teaching file.
a. Follow hospital dress code, i.e., wear blue lab coats, no open-toed shoes. Backpacks are to be stored in
a designated area within the department.
2. Attend imaging rounds or ultrasound laboratory with radiologists or residents from 9:00 until 11:00 a.m.
a. Report to the assigned technologist at 11:00 a.m. Your lunch time will be scheduled by the assigned
technologist and workload.
b. Students assigned for their week in ultrasound should report directly to the ultrasound at 11:00 a.m.
3.
4.
5.
6.
c. Whenever possible, two students are assigned to a technologist. Students must remain with the
technologist all day, until workload is completed or released to leave.
d. You should take turns restraining animals, processing film and viewing films with the technologist and
radiologist or resident on duty.
e. When appropriate assist with nuclear medicine procedures as needed when on US rotation.
f. When possible a student will be assigned to interpretation duty with the radiologist or resident.
g. Whenever appropriate you will do exams on your own under the supervision of the assigned
technologist. Check with technologist before beginning any clinical cases.
Free time - to make the most of the learning experience, prepare for the next imaging rounds, sit with
radiologist/resident, review teaching file cases or daily cases. If you leave the department for any reason, do
tell your technologist. She/he must know where to contact you at all times.
Film badges must be worn at all times on this rotation. Badge to be worn outside the apron at collar level.
Evaluation forms should be turned in to the office assistant at the end of your rotation.
If you must be absent from your scheduled imaging rotation, you must notify the Clinical Sciences office. A
form justifying your absence must be filled out. This form can be obtained in the Clinical Sciences office.
Abuse of arriving late and extended lunch hours will be considered absenteeism.
RADIOLOGY SAFETY PROCEDURES TO BE FOLLOWED BY ALL STUDENTS
AND PERSONNEL IN DIAGNOSTIC RADIOLOGY
1.
Monitoring
film
badges
are
to
be
worn
at
all
times
in
the
radiology
area.
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2.
3.
4.
5.
6.
7.
Lead aprons are to be worn by all personnel in the diagnostic room while exposures are being made.
Also available are lead gloves and thyroid shields to be used when appropriate.
No part of the body should be within the primary x-ray beam. This includes hands with lead gloves.
During x-ray exposures, personnel not required in the room should leave.
Pregnant women and individuals under 18 years of age should not be in the diagnostic rooms during xray exposures.
X-ray machines are to be used for diagnostic procedures on animals only, no human use.
Owners should not be in the diagnostic room when exposures are made.
WARNING: Excessive x-ray exposures may be harmful to your health.
ABSENCES
If you must be absent from your scheduled imaging rotation, you must notify the Clinical Sciences office. A
form justifying your absence must be filled out and turned in to the radiologist or resident teaching rounds that
week. If possible, avoid an absence on the last Friday of the rotation because a test is taken on that day. An
incomplete grade (I) will be given if a student does not take the exam on the third Friday of the rotation. The
test can then be taken at the end of the following rotation. This form can be obtained in the Clinical Sciences
office.
TESTING AND GRADING FOR THE ROTATION:
1.
RamCT Didactic Examination: All incoming seniors must complete an open book RamCT test by
Wednesday (or the third day) of the first week of the rotation. The purpose of the exam is to reinforce
knowledge of the previous PVM didactic radiology coursework. The test will consist of 30 multiple-choice
questions which will cover technical and physical aspects of radiography, radiographic anatomy, and
interpretation of radiologic abnormalities. The exam questions can be answered by reviewing the course
notes and textbooks from the prerequisite radiology classes. The exam can be taken anywhere that RamCT
can be accessed, via the Senior Radiology Practicum Course Page. This is an open book test. You are
allowed unlimited attempts at this test. After log in, go to Radiology Quiz Senior Practicum. Select
Examinations. Note: You will need to complete both Part I and Part II of the Radiology Rotation
Diagnostic Exam. On Part I you will only see the score.
If a score of 70% is not achieved the first time, the exam must be retaken before the end of the first week
of the rotation. If a score of 70% is still not achieved on the retake attempts, the student must report to the
radiologist on teaching duty that week for counseling. Students ultimately must score at least a 70% on
this exam to pass the senior radiology rotation. A printout of the test reflecting the students highest
score (preferably > 70%) must be given to the radiologist or resident teaching rounds in the 1st week of
the rotation. The final grade for the rotation will be based partly on the score for this exam, as described
below.
2.
Film interpretation examination: An open book written essay exam will be given on the last Friday of
each senior rotation, during the two-hour rounds time period. The test will consist of a written evaluation
of radiographs from approximately 5 of 6 cases. These cases will have abnormalities from the learning
objectives below. The students‟ answers should include a list of radiographic findings (abnormalities) and
an interpretation of those findings (which might include differential diagnoses). For example, if a case has
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abdominal radiographs showing a midabdominal mass, the findings would include a description of the mass
(opacity, location, size, margins, shape) and displacement of other abdominal structures. The interpretation
would include the possible organ involved (such as spleen or mesentery) and the possible disease processes
(such as neoplasia, hematoma, abscess, cyst). The exam will be graded by the radiologist on teaching duty
that week. Students must score at least a 70% on this exam to pass the senior radiology rotation. The
final grade for the rotation will be based partly on the score for this exam, as described below.
3.
Senior projects: Several projects are assigned during the radiology block.
1) An Ultrasound project (a written and oral case presentation of an interesting case where ultrasound
was used as an important diagnostic tool) will be presented and handed in during the week the senior is
on ultrasound duty.
2) A Technical Film/screen Radiography project is performed and presented by each senior. That
consists of the senior making a diagnostic set of radiographs on an animal during the first or second week
of the block, which the student must then assess as to the technical qualities of the study. The form at the
back of this syllabus should be used for a written and oral presentation of this project made before the
end of the second week. Note that one of the films need to be hand processed.
3) Radiology Projects - During teaching rounds each student will be asked to make a written and oral
assessment of a radiology case at least once a week. These can be current cases in the hospital, but could
also be older case material and should be identified by the student. The student should focus on the
radiology finding and incorporating these finding with the physical exam and clinical signs.
4.
Final Grade for the Rotation: The rotation is graded on a pass/fail basis. Students must score at least
70% on each of the above two exams to pass the block. Failure to get a passing grade on either exam by
the end of the block will result in written notification that the examination must be retaken and passed
before the end of that semester. If that does not occur, a failing grade will be recorded for the rotation.
Input for the final grade will also be based on quality of the Senior Projects, overall participation,
attendance, and performance during the block. This input will be provided by the Radiologists, the
Technologists and the Ultrasonographers. Be aware that poor participation, attendance or performance
could still lead to a non-passing grade despite passing grades on the examinations.
RADIOGRAPHIC INTERPRETATION
A.
Learning Experience
To assure that students are exposed to all aspects of routine imaging interpretation, a schedule will be
followed that includes all body regions and main species. This will be posted in the rounds room.
Cases will be reviewed each day with the students and self-teaching files will be available for study. In
addition, the fundamentals of imaging examination and interpretation of the abdomen, musculoskeletal
system, thorax and large animal radiology will be presented.
It is the student's responsibility to make sure that the teaching file is kept in order. Every effort should be
made to return the x-ray films to the proper envelopes. Please think of your colleagues in that regard. It
is your file, so please use it well and keep it functional.
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B.
Objectives
The students will be familiar with methods of routine imaging examinations, and will be expected to
recognize the following (the Film Interpretation Exam will use cases with abnormalities taken from this
list):*cannot cover all in rounds, students need to utilize text books and the teaching files that are
available.
1. Small Animal Abdomen:
a. Changes in size, shape, location, opacity, radiographic pattern of the following:
1) Liver
2) Large bowel
3) Spleen
4) Kidneys
5) Stomach
6) Urinary bladder
7) Small bowel
8) Prostate and uterus
b. General changes in opacity
1) Peritoneal fluid
2) Free peritoneal gas
c. Recognize and locate abdominal masses
d. Recognize signs of the following abnormalities as diagnosed by the appropriate contrast study:
1) Gastric or intestinal foreign body (as diagnosed by an upper GI study or survey
radiographs)
2) Gastric or intestinal mass lesion (as diagnosed by an upper GI study or survey
radiographs)
3) Urinary bladder neoplasia (as diagnosed by cystography or ultrasound)
4) Urinary bladder cystitis (as diagnosed by cystography or ultrasound)
5) Urinary bladder cystic calculi (as diagnosed by cystography, ultrasound, or survey
radiographs)
6) Ruptured urinary bladder (as diagnosed by cystography)
7a) Urethral calculi (as diagnosed by urethrography, survey films, or US)
7b) Urethral rupture
7c) Urethral neoplasia
8) Hydronephrosis and/or hydroureter (as diagnosed by intravenous urography or US)
9) Chronic renal disease (as diagnosed by intravenous urography or US)
10) Causes of renomegaly (neoplasia, hypertrophy, hydrnophrosis, infections, toxins,
abscess, cyst, hematoma)
11) Renoliths (radiopaque or lucent) (as diagnosed by intravenous urography, survey
rads, or US)
e. Recognition of the acute abdomen
1) Gastrointestinal perforation
2) Complete intestinal obstruction
3) Ruptured urinary bladder
4) Gastric volvulus
5) Pyometra
6) Fetal death and physical/anatomic causes of dystocia
2.
Abnormalities of the Small Animal Thorax; Be able to recognize:
a. Pneumothorax
b. Pleural effusion
c. Feline and canine pulmonary, alveolar, interstitial, or bronchial patterns.
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d. Cardiogenic pulmonary edema
e. Non-cardiogenic pulmonary edema
f. Metastatic and primary pulmonary neoplasia
g. Pulmonary contusion
h. Pulmonary hypertension
i. Hilar lymphadenopathy
j. Mediastinal masses
k. Mega esophagus
l. Cardiac enlargement, general and individual chambers
m. Common congenital heart diseases, i.e., PDA, PS, AS
n. Common acquired heart diseases, i.e., right and left AV valve insufficiency,
heartworm disease, feline cardiomyopathies, pericardial effusion
o. Abnormalities of the thoracic wall (rib fractures and masses), trachea (collapsing trachea),
traumatic diaphragmatic and peritoneo-pericardial diaphragmatic hernias
3. Small Animal Musculoskeletal System; Be able to recognize:
a. Stages of fracture healing and fracture complications (including osteomyelitis, sequestrum,
nonunion, malunion, pathological fracture)
b. Osteomyelitis
c. Bone neoplasia
d. Hypertrophic osteopathy
e. Common developmental skeletal abnormalities (osteochondrosis, ununited anconeal and
coronoid process, panosteitis, HOD)
f. Elbow dysplasia
g. Hip dysplasia
h. Degenerative joint disease, septic and immune-mediated arthritis
4. Large Animal Imaging - Be able to recognize:
a. Degenerative joint disease and septic arthritis
b. Osteochondrosis
c. Fractures
d. Navicular changes
e. Laminitis changes
f. Fractures of the third phalanx
g. Osteomyelitis/Sequestration
5. Neurological abnormalities; be able to recognize:
a. Fractured or luxated spine
b. Degenerative spondylosis and intervertebral disc disease
c. Vertebral osteomyelitis
d. Discospondylitis
e. Vertebral neoplasia
C.
EVALUATIONS
At the end of the rotation you will have the opportunity to evaluate your experience. If a situation should
arise that is of concern, please contact Dr. Randall at your earliest convenience.
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RADIOLOGY FILE CHECK-OUT
When choosing your cases for your presentation(s), the radiographs
MUST be checked out through the radiology office. You may choose
a case that was scheduled for an exam on that day, but again, they
have to be checked out through the office. Please keep in mind that
the clinician of record on the case has first entitlement to the
radiological file, please check with that clinician before pursuing your
interest for your projects. All other cases can be requested from the
office by completing the blue check out form inside the office window.
The clinician teaching for that week will be the clinicians name on the
blue check-out form. We also ask that the films are returned in the
correct jacket and that all requests/file folders are kept included with
the films.
125
RADIOLOGY TEACHING FILE
Veterinary Teaching Hospital
Colorado State University
PATIENT NUMBER:
SPECIES:
BREED:
AGE:
SEX:
PERTINENT HISTORY:
CLINICAL FINDINGS:
PERTINENT LABORATORY FINDINGS:
RADIOGRAPHIC FINDING AND INTERPRETATIONS:
FOLLOW UP INFORMATION AND OUTCOME:
126
ULTRASOUND STUDENT CASE REPORT
STUDENT NAME (optional):
PATIENT NUMBER:
JACKET NO.:
SPECIES:
AGE:
BREED:
SEX:
PERTINENT HISTORY:
CLINICAL FINDINGS:
Answer the following questions on the next page.
From the above information, what ultrasonographic studies are indicated?
What abnormalities do you see on the ultrasound study?
What are your differential diagnoses?
What additional procedures would you advise?
127
PATIENT ID NUMBER:____________________________
RAD. JACKET NO:____________
Ultrasonographic studies indicated:
Ultrasonographic findings:
List your differentials.
What additional procedures would you advise?
What was the final disposition of this case?
Pathology Number: ____________________
Date of Pathology:__________________________
128
Name___________________________
RADIOLOGY ROTATION
SENIOR STUDENT RADIOLOGIC EXAMINATION FORM
It will be the responsibility of each student to do one film/screen radiographic examination by yourselves
before the end of the radiology rotation. You need to schedule a time with the technologists to do a study. Please
do not perform the study during our busiest days (Tues & Thurs) or our busiest times (10A-2P) You will
perform one project on one patient. You will be allowed to repeat one film of the study. Familiarize yourself
with the appropriate machine, type of cassettes/screens needed before starting project. Use VTH sub animals,
your own or friends' animals, (no client animals) on your rotation to help. You will not be graded for poor
technique or positioning if you critique how you could have, or did to improve the radiographs in your
discussion with the radiologist.
NOTE: ONE FILM MUST BE MANUALLY PROCESSED.
USE X-RAY EQUIPMENT THAT IS REALISTIC TO VETERINARY PRACTICE.
Exam:
Measurements:
X-ray settings used:
YOU WILL BE ASKED TO CRITIQUE YOUR FILMS WITH THE RADIOLOGIST IN ROUNDS FOR:
1. Technique (overall radiographic exposure)
2. Positioning
3. Manual processing artifacts
4. Radiographic interpretation
Film critique:
Improvement:
129
DIAGNOSTIC IMAGING ROTATION
EVALUATION FORM
Please return to Radiology Office
My rotation was for the week(s) of ___________ to ____________
Overall evaluation of the quality of instruction provided by the following faculty
member:
Dr. ________________________
Excellent _______ Good _______ Fair ________ Poor ________
Comments related to quality of round and instruction:
Comments that would be of value to the instructor:
_____________________
Signature (Optional)
130
F. Diagnostic Laboratory
General Administration - Diagnostic Lab Service Samples
Samples from live VTH patients (with a VTH number) are entered either in the DLab main office (from 8:00
a.m. - 5:00 p.m) or placed (with the proper paperwork) in the hallway outside E102. Refrigerate samples as
appropriate.
As Diagnostic Lab accessions are completed, preliminary and final reports will be emailed to the addresses
given on the submission form. Permanent, final reports are sent directly to Medical Records.
For emergency cases, please call the Pathologist of duty at 297-1281 or the Laboratory Director
(Barb Powers) at 221-5729.
Samples from non-VTH veterinarians and clients, including animals arriving DOA with no VTH accession
number, become Diagnostic Laboratory accessions. It is essential that Diagnostic Laboratory accession
forms be filled out with a minimum of:

Veterinarian name, address, telephone.

Owner name, address, telephone.

Description of animal(s) including species, age, breed, and sex.

Pertinent history.

Owner‟s wishes for disposition of body.
During business hours, clients should be directed to the Diagnostic Laboratory main office. After-hours,
Diagnostic Laboratory forms are available in the necropsy laboratory (F101B) for animals submitted for
necropsy. Forms for other specimens are available in the foyer South of Large Animal Reception. Any
perishable specimens should be refrigerated in the after-hours refrigerator there. Whole animals may be
placed in the necropsy walk-in cooler after being legibly identified with a tie-on tag with the following
information: Owner Name, Date and Phone #. Necropsy services are routinely available at 9:00 a.m. on
Saturday and Sunday. See Section II for help with Diagnostic Laboratory submissions.
Testing for Rabies on Weekends: Weekend rabies testing may be requested on cases of known human
exposure, usually by a bite, by an animal suspected of having rabies, by an animal with an unknown history,
or by a wild animal (e.g., skunk, bat). Exposure is defined as an unprovoked attack in which a bite or other
event occurs that results in breaking the skin or potentially exposing broken skin to the animal's saliva.
Situations not fitting these criteria are not considered emergencies, and rabies exams will be performed on the
following Monday (see posted instructions in Necropsy office).
In addition, all species of rodents (mice, rats, hamsters, guinea pigs, squirrels, muskrats, gerbils) and rabbits
are not considered rabies hosts and will not be processed for rabies exams on weekends.
During weekends, animals submitted to the Diagnostic Laboratory for rabies exam can be tested on an
emergency basis. To initiate testing during the weekend, present the suspect animal and the completed
necropsy request form indicating a history of known human exposure. Please contact the on-call weekend
pathologist. These on-call individuals are listed on the Diagnostic Laboratory and Necropsy bulletin boards.
The brain will be removed for testing either at 9:00 a.m. Saturday or Sunday, depending on when the animal
is received.
131
For more detailed information regarding handling of suspected cases of rabies and rabies control and
prevention, please familiarize yourself with the section in the VTH Procedures Manual on Rabies.
All dead animals (CSU-VTH cases and non-VTH cases) become part of the Pathology rotation accessions and
are entered through the Diagnostic Laboratory. Outside cases use the request form with “Diagnostic
Laboratory” in the heading. Cases originating from the VTH (with VTH numbers) use the form with the
patient information imprint area in the upper right corner. Results are available from the pathologist on duty
of from the Diagnostic Laboratory.
Surgicals from the CSU-VTH are entered at the Diagnostic Laboratory and results are available from the
resident/pathologist on duty or from the Diagnostic Laboratory.
Specimens must be submitted by 3:30 p.m. for next day results.
Requests for results of Diagnostic Laboratory evaluations in progress are welcome but must observe the
following procedures.

You must have the Diagnostic Laboratory number assigned that sample.

To find the Diagnostic Laboratory number you need the date of sample entry to the Diagnostic
Lab test request, the owner's name and the clinic number.

Make your request only to the client service personnel in the Diagnostic Laboratory office. They
will give you the results or will direct you to the correct person in the laboratory.

Immediately write the results in an accurate, legible manner.

Results for single case findings will be given to one person or one group of persons only on any
given day. Consult with each other.
Some microbiologic evaluations will be reported when individual tests are completed, however, when all
evaluations requested on one form have been completed, one report form will be delivered to the
VTH medical records. Please check for this report before requesting results directly from the laboratory.
Faculty members can be contacted regarding problems with incoming specimens or cases in progress. Phone
numbers are posted in the VTH client services area. The names of the diagnostician, bacteriologist, and
virologist on weekend duty are also posted.
Diagnostic Lab Phone Number - 297-1281 (ext. 281)
Teaching Services
The Diagnostic Laboratory faculty is responsible for course instruction covering Diagnostic Laboratory
techniques and interpretation. This instruction is offered through VM724 and VM786D (Postmortem
Investigation).
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Bacteriology
Collection and Submission of Specimens
Introduction:
The purpose of the clinical bacteriology laboratory is to rapidly and accurately provide the clinician with
information concerning the presence or absence of a microbial agent, specifically or potentially involved in an
infectious disease process in a patient. Effective quality assurance cannot be accomplished unless
SPECIMENS OF OPTIMAL QUALITY are received in the laboratory. This specimen collection and
submission procedural manual has been prepared as a reference source of the preferred methods of handling
diagnostic submissions. Do not hesitate to call the laboratory (Ext. 327) for additional information or specific
instructions for special request submissions. The extra time spent in reviewing these instructions may avoid
the necessity of recollection of a proper specimen.
Collection and Transport of Specimens
General Instructions:
Swabs are acceptable for transportation of many specimens, provided a humidified transporting chamber such
as the Culturette is used. Pathogens may not survive on a dry surface, but the swab does NOT need to be
soaked in the fluid -- just crush the fluid ampule to create a humidified atmosphere.
Swabs that cannot be delivered to the laboratory within 8 hours should be placed in a non-nutritive semisolid
transport media such as Amies, Copan or Port-A-Cul. Do NOT submit swabs in nutrient media.
Swabs are NOT acceptable for submission of specimens for attempted isolation of Mycobacteria or fungi.
In general, swabs are incapable of yielding as much useful information about any type of microorganism as
can be obtained from tissue, exudate or fluid submitted in an appropriate closed sterile container.
Whenever possible, obtain culture specimens prior to the administration of antibiotics. However, the
administration of antibiotics does not necessarily preclude the recovery of bacteria from selected cases or
tissues where low antibiotic concentrations are achieved. However, the use of antibiotics should be noted on
the submission form.
Anaerobic Culturing
Indications: Suppurative infections, necrotic tissues, and infections in closed body compartments; especially
abscesses, pleuritis and peritonitis; fracture associated trauma to tissues; infections caused by the flora of
mucous membranes. Urine should not be submitted for anaerobic culture.
Collection: OXYGEN IS LETHAL. Submit as much of the micro-environment as possible and protect from
air.
A
sterile syringe and needle should be used to collect a generous quantity of liquid material from
unopened abscesses and body cavities. Express extra air and cap or transfer immediately to a
Port-A-Cul vial or Copan swab, available from the Diagnostic Laboratory.
 Open
wounds, ulcers and sinus tracts frequently become contaminated with numerous bacteria. Use
of a swab to collect material from these sites is of limited value, but acceptable IF placed in an
anaerobic tube such as Port-A-Cul or Copan swab, available from the Diagnostic Laboratory.
133
 When
Clostridium infections are suspected, submit a piece of tissue and several direct smears.
 Culturette
swabs will NOT be accepted for anaerobic culturing.
NOTE: Handling a specimen as if it contained anaerobes will not jeopardize the recovery of aerobic
bacteria.
Blood Cultures
Indications: Fevers of undetermined origin, signs of endotoxemia or septicemia (esp. in neonates),
positive serology for B. canis, etc.
Collection
a. Cleanse and decontaminate the skin using both alcohol and organic iodides.
b. By venipuncture, collect blood and immediately inoculate the recommended culture bottle,
available from the Diagnostic Laboratory.
Leptospira culturing is available only by prior arrangement with the laboratory.
Bone Cultures
Specimens from orthopedic procedures must be transported to the laboratory in a manner which prevents
drying. Each specimen should be accompanied by a smear prepared from the same site. Anaerobic
culturing is frequently indicated.
Ear Cultures
Culturette swabs are useful for collection and submission. ALWAYS submit a smear prepared from a
second swab.
Eye Cultures
Topical anesthetics often have antimicrobial activity; therefore collect culture specimens BEFORE any
topical medication is administered.
 Rub
a moistened swab over the conjunctiva or cornea. Insufficient numbers of bacteria will be
picked up on a swab that is lightly touched to the surface.
 Corneal
scrapings are a more productive sample. Direct smears should be made as well as direct
inoculation of media. Do NOT try to transport corneal scrapings to the laboratory because
drying cannot be prevented. Pick up media at the laboratory for direct, immediate inoculation.
Fecal Cultures
Culture of fecal specimens should be requested only when looking for specific agents. Fecal specimens
should be placed in a leak-proof, screw-capped sterile container. Rectal swabs (not anal swabs) should
always be accompanied by 2 to 5 grams of feces. In diarrhea cases, a single negative stool culture
cannot be regarded as sufficient for laboratory confirmation of noninvolvement of infectious bacteria.
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 Salmonella
- all fecal and rectal specimens are routinely cultured for this bacterium. Isolation of
other bacteria listed below is attempted only on special request. Fecal specimens from horses
should contain at least 15 grams.
 Campylobacter
- An increasingly important zoonotic bacterial enteritis. Submit 2-5 grams of feces.
 Mycobacterium
paratuberculosis - submit at least 15gm of feces in a small container (Whirl-pak or
fecal cup); also submit rectal mucosa.
 Clostridium
perfringens - fecal cultures of limited value; occasionally indicated for hemorrhagic
gastroenteritis in dogs and horses. For enterotoxemia, submit several ounces of fresh small
intestinal contents (collected within 5 hours of death). Samples must be frozen immediately.
Samples not arriving at the laboratory FROZEN will be discarded.
Fluid Cultures
A portion of any fluid is preferred to a swab.
Cerebrospinal fluid.
Specimens should be collected and transported in sterile containers. Since there are usually only a
small number of microorganisms present in infected CSF, always submit as large a volume as
possible.
Other fluids.
Percutaneous aspiration of pleural, pericardial, peritoneal and synovial fluids must be performed
aseptically. The specimen should immediately be injected into a sterile container for anaerobic
transport, such as the Port-A-Cul vial or Copan swabs.
Milk Samples
Satisfactory examination of milk for bacteria which may cause mastitis is dependent upon the collection
of samples FREE from contamination with extraneous organisms. Two to five ml. of milk should be
collected into a sterile container and refrigerated immediately. If transport to the lab is to be longer than
1 hour, the milk should be frozen.
Reproductive System Cultures

Uterine cultures - The vagina and external cervical area are normally contaminated with many
bacteria. Guarded culture swabs should be used for collecting from the cervix and uterus.
Isolation of the CEM organism requires special collection, transportation and media. Contact
the laboratory for specific instructions.

Campylobacter culture - Preputial washings, semen or cervical mucus should be refrigerated
and submitted immediately to the laboratory or inoculated directly into Clark's transport media,
available from the Diagnostic Laboratory.

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
Abortion
Bacteriological culture is of value only in selected cases. If tissues have undergone extensive autolysis and
putrefaction, culturing will usually be unprofitable. The most
important specimens for isolation of bacteria are:

a - stomach contents or submit entire fetus (whole fetus and placenta is optional)

lung

c - liver

d - placenta
Respiratory Tract Culture
 Upper
respiratory tract culturing has limited value because most animals carry numerous potential
pathogens as part of the normal flora. Cultures may have value for isolation of Streptococcus
equi in horses.
 Collection
of sputum or pharyngeal swabs is NOT recommended. Percutaneous tracheal aspirates
are the preferred lower respiratory tract specimens for culturing. DO NOT USE a solution
containing any preservatives or antimicrobial substances when aspirating for culture. A buffered
solution such as Lactated Ringers Injection, U.S.P., pH 6.5, is preferred.
 Mycoplasma
and Haemophilus are very fragile organisms. Specimens should be refrigerated or
placed in Amies transport media and transported.
Skin Cultures
 Bacterial
culturing is indicated only when specific lesions are present. Swabs, intracutaneous
aspirates and some types of scabs are useful submissions.
 Fungal
culture specimens should NOT be submitted on a swab. Wash the lesion, then pluck hairs
from the periphery and scrape the skin at the edges of the lesion. Submit these items in a dry,
sterile container.
Surgical Samples for Culture
Always try to submit pieces of tissue, surgical hardware, catheter tips and other foreign materials rather
than just a swab. Consider the need for anaerobic collection and handling. Samples from abscesses
should include a portion of the wall of the abscess along with pus.
Urine Cultures
Urine cultures should NOT be submitted on a swab. It is imperative that careful attention be paid to the
proper collection of urine as it is an excellent culture medium, and a small or insignificant number of
bacteria can multiply rapidly to significant numbers. A sufficient quantity of urine (1 ml) should be
submitted for quantitative culturing and must be delivered to the laboratory within 1 hour of collection
or it may be held under refrigeration up to 6 hours.
Leptospira culturing is performed only when specific arrangements have been made with the
laboratory. Dark-field examination may be requested as indicated.
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Wounds, Abscesses, Draining Tracts, Etc. Cultures
Obtain samples from the deeper parts of the lesion without opening it if possible. Anaerobes are
commonly recovered from these lesions so such material should be sent to the laboratory in an anaerobic
transport system.
Special Collection Requirements:
Anthrax - Aspirate blood from peripheral vessels and cells from superficial lymph nodes.
Prepare several smears and carefully package them for delivery to the laboratory.
CLEARLY LABEL SAMPLES AS ANTHRAX SUSPECT AND NOTIFY THE
LABORATORY BY PHONE.
Contagious equine metritis - Contact the laboratory for specific collection and submission
procedures. Culture of this organism is federally regulated and must follow certain procedures.
Leptospira - culturing of blood or urine will only be performed by special arrangement with
laboratory. Call to schedule culturing and for specific collection and submission
instructions.
the
Submission of Specimens to the Diagnostic Laboratory
Label all containers with an indelible marker providing the following information:

Clinic case number.

Date/Hour.

Owner name.

Individual code if more than one specimen for a case.
A submission form must be filled out. Use a Veterinary Teaching Hospital - Diagnostic
Laboratory Request form.

Enter Animal-Client information using the embossed card.

Record the veterinarian, date and a brief HISTORY which should indicate the diseased body
system or tissue. Note previous culture attempts and current antimicrobic therapy if any. In
addition, record if there is a suspicion of zoonotic agents.

If multiple specimens from the same case are submitted, code and identify them. Each
specimen must be in a separate container.

Requested service:
o
Anaerobic bacterial culture should be specifically requested and will include an aerobic
culture. It is not necessary to request both.
o
Fungal culture will be processed according to the HISTORY, i.e. dermatophytes or systemic
fungi.
o
Mycoplasma cultures will be reported as negative or positive unless specification is
specifically requested.
137
o
Mycobacterium culturing must be specifically requested.
o
Other special requests have been indicated in the previous section reviewing specimen
collection.
o
Antibiotic susceptibility will be tested by Kirby Bauer agar disk diffusion to determine the
zone of inhibition. The interpretation (S,I,R) will be reported. See the discussion on the
following pages for interpretation.
Results:
The following semi-quantitative notation is used on bacterial culture reports:
light growth, (+1)
=
few colony forming units recovered, often requiring
subculture from enrichment broth for recovery
moderate growth, (+2) = if isolated as the only organism and is known to be a
potential pathogen or there are clinical signs
consistent with infection, this result is probably
significant. Isolation of several organisms or
nonpathogens indicates that this organism may be
insignificant.
heavy growth, (3+) = isolates are usually significant unless recovered
from a site that is normally colonized by microflora.
Antimicrobial Susceptibility Test Procedures and Reports
Antimicrobial susceptibility testing has become established as one of the laboratory procedures that have
significant impact on the prescribing of antimicrobial drugs. In order to improve the predictive value of
antimicrobial susceptibility tests, the Diagnostic Laboratory uses a customized susceptibility test system.
All susceptibility tests are performed by agar disk diffusion method (Kirby-Bauer), which is based on the
ability of an antimicrobial agent contained within a paper disk to inhibit growth of a bacterium on an agar
plate. The zone of growth inhibition is interpreted as sensitive, intermediate, or resistant according to
published interpretive charts (NCCLS guidelines). This method determines a qualitative susceptibility value
which will be reported as follows:
Sensitive: The organism is inhibited by levels of antimicrobic attained in blood or tissue on usual dosage,
including oral administration.
Intermediate: The organism is inhibited only by blood levels achieved with maximum dosages, usually
requiring IV administration with increased frequency. (In some animals, these dosages may be toxic).
Resistant: The organism is resistant to usually achievable clinical concentrations of the antimicrobial.
Six separate panels of antimicrobial agents will be available for testing bovine, canine/feline, equine, porcine,
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avian/fish, and mastitis bacterial isolates. Antimicrobial agents used for each panel have been selected to
correlate with usage in that particular animal species. Several antibiotic tests are available by request and
include rifampin and ticarcillin.
Other notes regarding antimicrobics are as follows: cephalothin results apply to all first generation
cephalosporins; tetracycline is a class test; ampicillin results also apply to amoxicillin; clidamycin results also
apply to lincomycin; oxacillin is a class test for all beta-lactamase resistant penicillins. Trade names are as
follows:
Albion = sulfadimethoxine
Baytril = enrofloxacin
Timentin = ticarcillin / clavulanic acid
Naxcel = ceftiofur
Primor = ormetoprim / sulfadimethoxine
Micotil = tilmicosin
Tribrissen = trimethoprim / sulfadiazine
Collection and Fixation of Samples for Histologic Evaluation
Histologic evaluation of tissues can be a valuable adjunct to clinical and gross morbid examinations. Its value
is enhanced by proper selection of samples and good fixation.
Procedures that will increase the quality of the sample and improve the result of evaluation include:
Collection
Samples should be from areas and tissues that show gross changes or that may be
expected to contain changes, e.g. lung and liver of aborted equine fetuses suspected of
having an infection by equine rhinopneumonitis virus. Numerous samples should be
collected so the pathologist can select the appropriate ones.
Biopsies or samples of neoplasms should be representative of the tissue being sampled
and should be large enough to allow for good interpretation.
Tissue presented should be + 5 mm thick and + 2.5 cm square. If a large mass is
presented, make parallel incisions from the outer surface to near the deep surface at + 1
cm intervals.
With neoplasms be sure the base of the mass and edges allow an evaluation as to
completeness of removal.
Do not rub, wash, crush or swab tissues to be used for sectioning. Electrocautery in
excess also damages the tissues.
Do not tie off sections of intestine that are to be fixed. Make the sections short enough to allow exposure to
fixatives.
139
Fixation
For general use 10% neutral buffered formalin is suggested (3.8% formaldehyde gas in
water with phosphate buffer).
For eye fixation Bouin‟s Fixative or 10% neutral buffered formalin is recommended.
Glacial acetic acid should be added (5% of total volume) immediately before the tissue is
exposed to the fixative. See top of next page for fixation protocol.
To enhance staining of inclusion bodies, Bouin's fixative or Zenker's solution are
suggested.
Duration of the fixation period varies for each product used, the type of tissue being
“fixed", and size of tissue.

Formalin - generally 1-5 days minimum with no maximum.

Zenker's - 6-12 hours in solution and then dilute to 50% volume with water and fix
for 6 more hours. This should be followed by washing in running water for 24-48 hours and
stored in 70% alcohol.

Bouin's - 6-12 hours maximum depending on size and type of tissue followed by
wash in running water for 24-48 hours. Storage is in 70% alcohol.

Quantity - 1 part of tissue to 10 parts of fixative by volume is sufficient.
Staining
Routine staining uses Hematoxylin and Eosin (H&E). Special stains are made by request
usually following consultation with a pathologist.
Shipping
If samples are to be shipped, it should be done in nonbreakable and leak proof bottles
packaged in water tight containers or containers with absorbent padding. If large tissues are to be shipped
(horse brain, etc.) the tissue should be well fixed and then shipped in a small
amount of fixative or storage fluid.
Samples originating from the VTH are processed through the Diagnostic Laboratory.
Turn around time for routine fixed tissues at the Diagnostic Laboratory is less than 24 hours (1 working
day). Tissues that must be demineralized or be subjected to special techniques may require up to 10 days.
For special evaluations, contact a pathologist.
Endocrinology Section
All endocrinology assay specimens for the Endocrinology Laboratory should be delivered to the Diagnostic
Laboratory Entry Room with a completed Endocrinology Request form. The Diagnostic Laboratory is
responsible for entering submission, billing, and reporting final
results.
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Tests Available:
Endocrinology Lab:
Cortisol
T3, T4, endogenous TSH
Progesterone
Testosterone
LH
Endogenous ACTH (plasma)
Clinical Pathology:
Special Assays - outside laboratories
Samples: All tests require 2 ml of refrigerated or frozen (-20C) serum or plasma (collected in EDTA).
Postmortem Investigation Practicum
Necropsy Laboratory Conference Room F100, VTH
General Information
Duty Hours:
Hours for seniors students are normally 8:30 a.m. - 5:00 p.m. Monday through Friday (or as modified by the
duty pathologist after the first day). Additional hours are Saturday, Sunday, and holiday mornings until cases
for necropsy are completed. Junior elective students are on duty weekday mornings 8:30 a.m. - 12:00 noon at
the same time as the seniors. Juniors are not assigned weekend duty except under special circumstances.
General activities
8:30 on weekdays.
Meet in room F100 for pre-session to discuss previous and newly submitted cases. On Wednesdays
microbiology topics are discussed at 8:30 am.
AM Necropsy Session
11:30 AM Minirounds - case discussions
PM. Necropsies, Laboratory Follow-up, Self-study
Friday, 1:10 PM Weekly Anatomic Pathology Conference
Students will provide their own heavy rubber gloves, knives, and rubber boots. Coveralls may be provided by
students, or may be obtained from the pool of SCAVMA-donated coversalls maintained by Central Supply for
student checkout. Dress will be coveralls and rubber boots. The boots and coveralls should not be worn
outside the necropsy area. Boots should be thoroughly washed and disinfected after each use and worn to the
locker room. Soiled coveralls should be replaced by the following day. No one is allowed on the necropsy
room floor without rubber or plastic boots and protective clothing.
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Students are responsible for helping maintain cleanliness and order during duty hours and should leave the
necropsy floor, tables, etc. in a sanitary condition. Instruments, tools, etc. should be left clean and properly
stored.
Students should be familiar with the necropsy protocols that are attached or available on-line.
Objectives - During the Postmortem Investigation Practicum, students will:

Learn necropsy technique (with emphasis on track orientation when possible).

Learn to interpret and act on necropsy findings (with emphasis on track orientation when possible).
o
Differentiate postmortem and antemortem changes.
o
Make morphologic diagnoses.
o
Formulate working hypotheses relative to etiology and pathogenesis.
o
Formulate diagnostic strategies to confirm etiology and pathogenesis.

Learn to utilize laboratory diagnostic support services.

Methods of tissue collection and preservation

Sampling strategy
o For surgical pathology
o For necropsy pathology

Histology

Microbiology and toxicology laboratory

Common problem areas and errors.
Specific activities occurring during the 2 week rotation period
Necropsy
Each necropsy will be performed in its entirety by one assigned student under the direct supervision of a
pathologist. He/she shall be assigned full responsibility for evaluation of the clinical record, for attention to
special written requests indicated on the necropsy request form, for overall conduct of the necropsy, and for
evaluation of all organs and tissues. Assistance received from others will not diminish this responsibility.
The responsible senior student shall also write up the gross necropsy findings on a provided worksheet. These
descriptions should be written in present tense and use simple descriptive terminology that indicate size,
color, location, texture, distribution, and odor. The gross necropsy worksheet shall be completed as soon after
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the necropsy as possible and left in the student‟s folder before leaving the necropsy area. After necropsies are
completed, the responsible student for each assigned case shall demonstrate the lesions found and interpret
those lesions (and the case) for the other students, resident and pathologist. No organs or tissues may be
discarded prior to this review of the case, except by assent of the instructor.
Case Analysis (written)
Each senior student will write one (due Friday of each week) “in-depth” Case Analysis each week of rotation,
usually taken from the daily surgical pathology or necropsy case submissions. Please refer to the outline at
the end of this section for hints on the format and aims of these case analyses.
These reports are meant to be a comprehensive learning experience. The students are expected to consult
textbooks and current journal articles with computer literature searching resources. Lecture notes are not an
acceptable sole source. Do not just repeat the discussion in the necropsy laboratory.
Case Follow-up
Laboratory Follow-up. Necropsy cases may have samples submitted to the other diagnostic laboratory
sections for microbiologic or toxicological evaluation. Some of these will be assigned to senior students to
track through the laboratory in order to understand the techniques involved and the results. This information
will be presented to the rest of the practicum group.
Histology Follow-up. Tissue samples from necropsy cases with interesting or confusing gross lesions may be
submitted to the histology laboratory for expedited processing of histology slides. The assigned senior
student will examine these slides, write a short evaluation, and present the findings to the rest of the group.
Self Study Instruction
During the 2 week senior student rotation, there will be time that is available for performing activities related
to necropsy case material or assigned readings. These activities will occur in the Pathology conference room,
the computer lab, or the VTH library. In addition, there are video tapes that can be viewed when there is time
available.
Computer work stations are available for on-line searches and report preparation.
Mini Reports
These are short written or oral reports that address questions generated by the necropsy case activities. They
are assigned as the questions arise and will usually be presented to the group.
Gross Necropsy Demonstration
Each student will demonstrate a complete necropsy of a horse, ruminant or a small animal depending on the
track orientation.
Grading
Pathologists will grade the students on mastery of the above objectives on a Pass/Fail basis. A written
examination may be administered on the last day of the rotation.
Necropsy Technique
Because of anatomic differences among the various kinds of animals, the methods for performing necropsies
143
vary. Procedures for various species follow. Techniques for examining the heart, brain, and spinal cord are
given separately. Additional information, see "The Necropsy Book" by King, Dodd, Newson, and Roth.
Necropsy of the Carnivore
1.
Review the history and consider all likely diagnoses. Note any special requests on the necropsy request.
2.
Make an external examination of both sides of the cadaver noting any surgical incisions, swellings,
fractures, parasites, lesions, etc. Be sure to examine the ears, eyes, and mouth, genitalia and perineum.
3.
Place the animal in dorsal recumbency with the head toward the right of the prosector and the tail at the
lower, free end of the table.
4.
Make a mid-ventral longitudinal incision from the chin to the anus. Reflect the skin and legs laterally
and male genitalia posteriorly. Disarticulate both coxofemoral joints. When properly prepared, the
limbs are extended laterally and the animal is maintained in dorsal recumbency.
5.
Beginning at the pubis, make an elliptical incision in the ventral abdominal musculature to the xiphoid
process. Check for negative pressure in the thorax making a small incision in the diaphragm and
listening for the air rushing in. With an osteotome or shears cut the ribs at the costochondral junction
from the last rib to rib #1. Strip the right 4th or 5th rib and test its resistance to breaking. Using a
knife, remove the thoracic wall and simultaneously cut the ventral cervical muscles from the sternum to
the larynx.
6.
Examine the abdominal and thoracic viscera in situ. Consider the advisability of culturing or saving
tissues for histopathology.
7.
Excise the omentum and spleen by transecting attachments.
8.
Examine the dorsal and ventral aspects of the pancreas.
9.
Transect the rectum at the pelvic inlet. Strongly tense the rectum and, detach the rectum, cecum and
small intestine from its suspending mesentery. Transect the duodenum at the posterior end of the
pancreas. Cut the mesentery from the small intestine close to its line of attachment so that the small
intestine lays straight and can then be opened longitudinally along the line of mesenteric attachment. To
avoid contaminating the viscera and table, the intestine will be opened along its mesenteric attachment
as the last step.
10.
With the stomach still in place, open the anterior duodenum longitudinally and examine the papillae
where the bile and pancreatic ducts enter the duodenum. Apply pressure to the gall bladder to check for
patency of the bile duct by the discharge of bile.
11.
Transect the esophagus at the cardia. Transect the gastric mesentery and the bile duct. Remove the
stomach with the duodenum and pancreas attached. Incise the stomach along its lesser curvature.
12.
Excise the adrenals, then the perirenal fat and kidneys with the ureters attached. Alternatively, with
urinary disease you may prefer to keep the entire urogenital tract intact and remove it as a unit. Cut the
144
kidneys longitudinally into two equal halves and strip the capsule.
13.
Together remove the liver, the attached complete diaphragm, and posterior vena cava.
14.
Remove the ventral aspect of the pelvis after making cuts with bone shears anteriorly and posteriorly
from each obturator foramen. Open the bladder and the complete urethra. Reflect all pelvic organs
posteriorly and remove them. Separate the rectum and anus from the other organs. Open the genitalia
and rectum.
15.
Beginning at the tongue, loosen, retract and remove as a single mass the tongue, larynx, trachea,
thyroids, esophagus and thoracic viscera.
a.
b.
c.
d.
e.
f.
Open the esophagus longitudinally and then remove it.
Examine the thyroid glands and parathyroids.
Examine and incise all lymph nodes.
Open the larynx and trachea. After separating the left and right lungs from the heart and
mediastinum, open the pulmonary veins, pulmonary arteries, and major bronchi.
Incise, examine and remove the pericardium noting the characteristics of the pericardial fluid.
Examine the heart and aorta. In opening the heart use the technique described elsewhere in this
manual.
16.
Skin the head and then disarticulate it at the atlanto-occipital articulation. Remove the brain. Open all
sinuses and the bullae of the middle ears. Examine the teeth. Remove spinal cord.
17.
Muscles, bones and joints are examined after removal of the overlying skin and dissection of the
pertinent part.
18.
Record all necropsy findings in writing.
Necropsy Technique for Ruminants
1.
2.
Review the clinical history and consider all possible diagnoses. Note any special requests.
Place the ruminant in left lateral recumbency, if possible with the back higher than the ventrum. This
position permits the removal of the smaller abdominal viscera without disturbing the lower and larger
organs.
3.
Incise the skin along the ventral mid-line from the chin to the anus. Avoid making any other skin cuts as
they will ruin the hide. Cut above the sheath or mammary gland and from the inner to the outer side of
the skin. Reflect dorsally the skin and both limbs of the right side. Disarticulate the right hind limb at
the femoral joint. Upon completion both limbs will be at right angles to and above the back.
4.
The abdomen should be opened and explored before opening the thorax. Cut into the abdomen below
the tuber coxae. Avoid puncturing an intestine. Extend the incision anteriorly ventral to the lumbar area
to the ribs. Continue the incision posteriorly and ventrally to the mid-line and then anteriorly toward the
xiphoid cartilage.
5.
Make a small incision in the diaphragm and listen to determine if there is a negative pressure in the
thorax. With orchard (bone) shears, ax or cleaver, cut the ribs from behind forward, staying ventral to
145
the longissimus dorsi muscle.
6.
After lightly incising the right costo-chondral junctions on their medial aspect reflect the ribs and right
abdominal wall ventrally until the costo-chondral junctions are fractured and the body wall remains in a
ventrally reflected position. Alternatively the thoracic may well be removed.
7.
Examine the abdominal and thoracic cavities for abnormalities. It may be advisable to take cultures at
this time since further manipulations will soon contaminate the organs. You may also wish to take
tissues for histopathology as the necropsy proceeds.
8.
Remove the omentum after cutting it close to visible attachments.
9.
Palpate between the reticulum and diaphragm for adhesions or penetrating foreign bodies. In cows
remove the mammary gland and supramammary lymph nodes and examine them.
10.
Remove the right adrenal which is adjacent and posterior to the liver and anterior to the right kidney.
Strongly reflect the right kidney and its perirenal fat posteriorly while the renal artery and vein on the
anteromedial aspect are cut. The ureter will remain attached and should be stripped out back to the
bladder.
11.
Transect the duodenum on each side of the entrance of the bile duct leaving a few inches of the
duodenum attached to the bile duct. Examine the pancreas which is posterodorsal to the same area.
12.
Transect the colon at the pelvic inlet. Then while pulling the end ventrally, transect its mesentery. Then
grasp the entire mass of intestines, pull them anteroventrally and transect the mesenteric attachment as
far dorsally as possible. Remove the mass of intestines.
13.
Cut the mesentery from the small intestine close to its line of attachment so that the small intestine lays
straight and can then be opened longitudinally along the line of mesenteric attachment. The ansa spiralis
can be unwound as a double fold starting at the center of the ansa; alternatively it can be opened and
examined in situ.
14.
Remove the left adrenal, left kidney and attached ureter.
15.
Remove the forestomachs, rumen and spleen as a single mass. This process is facilitated by strong
antero-ventral traction by an assistant while the dorsal attachment and esophagus are transected. After
removal, separate the spleen from the rumen and examine it.
16.
Transect the reticulo-omasal junction, separating the omasum and abomasum from the rumen and
reticulum. Beginning from behind, incise the rumen and reticulum on the mid-dorsal line. Examine and
remove the contents. Wash the rumen out using cold running water. Remove the omentum from the
abomasum and incise the abomasum along its lesser curvature. Extend the cut through the omasal
sulcus. Examine and remove the contents and wash out both structures with cold water.
17.
Remove together the diaphragm, the attached liver and all possible posterior vena cava. This is most
easily accomplished if the thoracic viscera has been removed previously; if not, those structures that
penetrate the diaphragm on its anterior aspect must first be transected.
146
18.
Saw across the shaft of the right ileum just anterior to the acetabulum. Saw through the symphysis of
the pubis. Pry open the right side of the pelvis. Remove as a mass the rectum, genitalia and bladder.
After separating the rectum and anus, open all the structures removed. In males, next remove the sheath,
penis and testes and examine those.
19.
After transecting the attachments of the tongue to the mandible, retract the tongue. (It may be helpful to
split the mandibular symphysis). Disarticulate the hyoid at the middle cornua. Then retract the tongue,
larynx, trachea and esophagus into the thoracic inlet by cutting all soft tissue attachments. While lifting
on the esophagus and trachea, incise the mediastinum dorsal to the aorta, the sternal attachment of the
pericardium (avoid cutting into the pericardial sac). In front of the diaphragm transect all the structures
that penetrate it and then remove the lungs and all attached organs and structures.
20.
Lay the lungs on a table with the tongue to the right. Palpate the lungs deeply to detect lesions not
grossly visible on the surface.
a.
b.
c.
d.
e.
f.
Open the esophagus longitudinally and then remove it.
Examine the thyroid glands and parathyroids.
Examine and incise all lymph nodes.
Open the larynx and trachea. After separating the left and right lungs from the heart and
mediastinum, open the pulmonary veins, pulmonary arteries, and major bronchi.
Incise, examine and remove the pericardium noting the characteristics of the pericardial fluid.
Examine the heart and aorta. In opening the heart use the technique described elsewhere in this
manual.
21.
Skin the head and then disarticulate it at the atlanto-occipital joint.
22.
Remove the brain using the technique described elsewhere in this manual.
23.
After splitting the mandibular symphysis, split or saw the head longitudinally along its median line and
while viewing its ventral aspect. Remove the nasal septum. Examine the turbinates and the teeth. Chop
or saw across each half of the head to examine the maxillary sinuses.
24.
Remove the spinal cord using the technique described elsewhere in this manual.
25.
Muscles, bones and joints are examined after removal of the hide and careful dissection of the pertinent
part.
26.
After completing the necropsy, all organs and debris are placed in the body cavity. The right body wall
and limbs are returned to their normal position and the mid-line skin incision is laced together with
heavy cord or wire. (If the necropsy is conducted in the field).
27.
Record all necropsy findings in writing.
Necropsy of the Solipeds
Familiarize yourself with the technique for the ruminant. This technique is abbreviated and presumes
147
knowledge of the ruminant technique.
1.
Review the clinical history and consider all likely diagnoses. Note any special requests.
2.
Examine the cadaver, turning the animal over as needed. At the conclusion of this step the animal
should be in right lateral recumbency with the back higher than the ventrum.
3.
Make a mid-line incision from the chin to the anus staying above the sheath or mammary gland. Do not
ruin the hide by making transverse cuts from the mid-line incision. Reflect the left legs and skin up and
over the back, opening the left hip joint as needed.
4.
Check for negative pressure in the thorax by making a small cut between the ribs. Listen for air rushing
in.
5.
Make a small opening into the peritoneal cavity just below the point of the hip. Extend the cut forward
to a point on the last rib just below the large back muscles. Also extend the cut postero-ventrally to the
midline and then forward for a few cm. Using orchard (bone) shears cut through the ribs from the last
through the first ribs staying below the heavy back muscles. After cutting the diaphragm near the body
wall and the left costo-chondral junctions lightly on their medial side, the entire body wall can be
reflected ventrally. Examine all viscera in situ and check for exudates or transudates in the body
cavities. Consider the advisability of culturing and taking tissues for histopathology.
6.
Remove the omentum and spleen together. Then reflect ventrally the single loop of small intestine that
lays over the anterior mesenteric artery.
7.
Pull the pelvic flexure of the large colon ventrally so that it and most of the large colon are at right
angles to the body. Throw the small colon over the back, then tie it off at the pelvic inlet and at the
transverse colon; remove the part of the small colon and its mesentery which lays between the two ties.
Remove the left adrenal, then the left kidney and its attached ureter.
8.
9.
Open the abdominal aorta from the thorax to the bifurcation. You may wish to wipe out the blood with
paper towels. Using the sharp scissors, open the anterior mesenteric artery and as many of its branches
as possible. After removal of the cecum and colon, opening of the branches may be completed.
10.
Remove the small intestine by transecting the ileum, duodenum, and mesentery. A short segment of
ileum and duodenum is left on the cecum and stomach respectively. Alternatively, you may prefer to
remove the small intestine by tensing it against the mesentery and cutting it free of the mesentery close
to the mesenteric attachment. Then remove the mesentery.
11.
Together remove the large colon, cecum, and the anterior mesenteric artery with a 15 cm section of the
adjacent aorta. This will be a bloody operation since you will transect the posterior vena cava and the
portal vein. Some prosecutors find it easier if done while reflecting the large colon and cecum over the
back. Others prefer to reflect the structures ventrally. Once removed, the branches of the anterior
mesenteric artery can be opened further.
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12.
Remove the stomach and attached portion of the duodenum by transecting the esophagus (at the cardia)
and the mesenteric attachments.
13.
Remove the right adrenal and the right kidney with its attached ureter. The right kidney lies in a deep
notch in the liver and some prosecutors prefer to remove it with the liver.
14.
Together remove the liver, diaphragm and most of the posterior vena cava.
15.
After sawing across the shaft of the ilium (anterior to the acetabulum) and through the symphysis of the
pubis, pry open the pelvis and then remove all the pelvic viscera together by reflecting it posteriorly and
cutting soft tissues as needed. Separate the rectum and anus from the other pelvic viscera and open all
the structures. In males, next remove the penis and sheath, the scrotum and contents and examine them.
In females, remove and examine the mammary gland.
16.
Remove the tongue, pharynx, larynx, trachea, esophagus, heart and lungs and examine them in a manner
similar to that described for ruminants.
17.
Skin the head and remove the brain and examine it.
18.
Examine the muscles, bones and joints as in ruminants. Do not ruin the hide above the knees and hocks
but skin the animal properly as needed to accomplish these examinations.
19.
Restore the body as with ruminants after putting all the examine and empty organs back in the thoracic
and abdominal cavities. Lace up the ventral mid-line incision with cord or wire. (If a field necropsy.)
20.
Record all findings in writing.
Necropsy of the Pig
A necropsy of a pig is similar to the necropsy of a carnivore with the following modifications or additions.
1.
After the head has been removed, saw transversely across the snout of the pig at a point slightly
posterior to the usual position of the commissures of the mouth through the upper 2nd premolar.
Examine the turbinates.
2.
Remove the intestinal tract after transecting the rectum, esophagus and the mesentery at its sub-lumbar
attachment. Then separate the small intestine from its mesentery by cutting along the line of attachment.
Alternatively, pull the small intestine, with minimal cutting, from its mesentery. Then cut the mesentery
at its sublumbar attachment and remove it and the spiral colon.
3.
Unwind the spiral colon by blunt dissection. Open the entire intestine along the line of mesenteric
attachment.
Necropsy of the Fowl
1.
Review the clinical history and consider all likely diagnoses.
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2.
Examine the externa. Pay particular attention to abnormalities of the hocks, tendon sheaths and sinuses.
Check for external parasites.
3.
If alive, the fowl may be killed by any of three methods:
a.
Disarticulate the head at the atlanto-occipital joint. This procedure is accomplished by grasping
both legs and all primary wing feathers in the left hand. The thumb of the right hand is placed
over the dorsal surface of the atlas and axis, and the right first finger is placed on the ventral
surface of the mandible. The head is extended dorsally at a right angle with the vertebrae, and a
quick anterior pull on the head will disarticulate the head and sever the cord. To obtain greatest
leverage the dorsal surface of the bird should rest against the anterior surface of your right thumb.
b.
Inject 10-25 cc of air directly into the heart; use a glass syringe.
c.
Sever the cervical spinal cord by applying an emasculatome to the neck just below the head.
4.
Moisten the feathers with water containing detergent. If chlamydiosis is suspected, the bird should first
be soaked in 5% Lysol solution and then the necropsy should be performed in a glove hood or laminar
flow hood.
5.
With scissors, cut through the lateral commissures of the mouth and examine the oral cavity.
6.
Beginning at one commissure of the mouth, make a longitudinal, monolateral incision through the skin
of the neck posteriorly to the thoracic inlet. Reflect the skin laterally and examine the paired vagus
nerves.
7.
Make a longitudinal incision in the esophagus and crop. Note the content and odor.
8.
9.
Make a longitudinal incision in the larynx and trachea and examine.
With tin snips or heavy scissors, remove the upper beak by a transverse cut at the posterior commissure
of the mouth. This will allow inspection of the nasal cavity and will expose the anterior end of the
infraorbital sinuses.
10.
Inset one blade of a sterile scissors into the infraorbital sinus. Make a longitudinal lateral incision
through the wall of each sinus and examine them. Culture the sinuses if indicated.
11.
Incise the loose skin between the medial surface of the thighs and abdomen. Reflect the legs laterally
and disarticulate the hip joints. Incise longitudinally the skin on the medial aspect of each leg and
reflect it to expose the leg muscles and stifle joints.
12.
Connect the lateral skin incisions with a transverse skin incision across the middle of the sternum.
Reflect the skin of the breast anteriorly, that of the abdomen posteriorly. Be careful to maintain the
sterility of the uncovered skinned abdomen.
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13.
Make a longitudinal incision through the pectoral muscles on each side and over the ventral
costochondral junctions. The anterior end of each incision should intersect the thoracic inlet at the
dorso-ventral midpoint. With heavy scissors cut the underlying bones.
14.
With sterile scissors make a transverse incision through the posterior part of the abdominal muscles. On
each side continue the incision anteriorly to the cuts made at the costochondral junctions. Remove the
abdominal wall and breast, observing air sacs as they are town during removal.
15.
Examine the viscera and air sacs in situ.
16.
Using sterile instruments remove any organs and take any swabs desired for culturing. The spleen can
be exposed aseptically by freeing the left margin of the gizzard and reflecting that organ to the bird's
right side. All unnecessary manipulations and delays prior to culture increase the probability of
contamination. Take intestinal cultures last.
17.
Examine the pancreas. Transect the esophagus at the anterior border of the proventriculus. Then
unwind the entire gastrointestinal tract by tensing it while cutting the mesenteric attachments. Remove
it after transecting the rectum.
18.
Remove and examine the liver and spleen.
19.
Examine the gonads. In the female remove the ovary and oviduct and open the oviduct longitudinally.
20.
Examine the ureters and kidneys in situ. If indicated you may remove them for closer examination.
21.
Remove and examine the heart.
22.
Examine the lungs by reflecting them medially from between the ribs.
23.
With an enterotome make a longitudinal incision through the proventriculus, ventriculus, small intestine,
ceca, colon, and cloaca. Examine for lesions and parasites.
24.
Examine the paired brachial and sciatic nerves. The brachial nerves are visible anterior to the first ribs.
Expose the extrapelvic portions of the sciatic nerves.
25.
Disarticulate and skin the head. Remove and examine the brain.
Special Organ Examinations
1.
Opening the Heart
As with other organs the examination of the heart at necropsy may vary as dictated by the presence of
implication of specific disease processes. For example, if one suspects a congenital anomaly you should leave
the lungs attached to the heart at least until the presence of absence of abnormal venous drainage is
established by opening the atria and, in a retrograde manner, tracing the vessels. The opening of specific
chambers might vary, depending on the specific defect or anomaly suspected. The following method is useful
in routine examination of the heart and great vessels after the lungs have been removed:
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Open and remove the pericardium taking note of abnormal contents or surfaces. Note the general
configuration of the heart taking specific care to discern the relative size and shape of the various chambers
as viewed from the exterior. The flaccidity or apparent firmness of the myocardium may relate to the
degree of systole at time of death or to real changes associated with cardiac dilatation and/or hypertrophy.
Open both atria with longitudinal incisions along their superior borders. Remove clotted blood and examine
interior surfaces and atrial aspects of the AV valves. Remove clotted blood from ventricles and wash out
with water. Fill the ventricles with water and apply moderate external pressure to the ventricles which
forces the AV valves toward their closed position. This will give an approximation of the functional
competence of the valves and allows examination for ruptured chordae tendineae. This procedure is
particularly helpful in examining the canine heart.
Insert the point of a knife or scissors through the right AV orifice into the right ventricular chamber and
incise the right ventricular muscle along its septal attachment extending the incision to the apical portion
of the right ventricle and then dorsally along or out the pulmonary out-flow tract, through the pulmonic
valves and into the pulmonary artery. Cut moderator bands and restricting chordae tendineae so that the
right ventricle flap may be reflected dorsally. Examine the right ventricular chamber, ventricular
myocardium, A-V valve, pulmonary out-flow tract, pulmonic valve and pulmonary arteries for
abnormalities. Check for closure of ductus arteriosis. Dissect the pulmonary artery free from aorta and
reflect towards the base of the heart.
Placing the point of the knife or scissors through the left AV orifice and into the left ventricular
chamber, cut through the middle of the ventricular myocardium to the left ventricular apex. Place point
of knife or scissors into the aortic out-flow tract and cut dorsally through the aortic valves and into the
aorta. The previous dissection in which you reflected the pulmonary artery, allows the aorta to be
opened without further transaction of the pulmonary artery. Examine the left ventricular chamber, left
A-V valve, ventricular myocardium, aortic out-flow tract, aortic valve, coronary ostia, and aorta. Using
a scissors open the main branches of the coronary arteries.
The opening of the heart in the above manner gives a good general exposure of all chambers and valves
of the heart and allows you to "reconstruct" the organ for reorientation or examination. If ventricular
ratios are to be determined the location of the incisions through the myocardium must be along the
ventricular septal borders. Details of this procedure will be demonstrated.
2.
Removing the Spinal Cord
Small carnivores: After skinning and removing the head, place the animal in ventral recumbency with
the anterior cervical vertebrae flexed over the edge of the table. Make a mid-dorsal incision from the
first cervical vertebra to the base of the tail. Reflect the skin laterally along the entire incision. Remove
all soft tissues lateral to the dorsal spines and dorsal to the lateral vertebral processes. Beginning at the
first or second cervical vertebra remove the spines and arches of all the vertebra. This can be done using
a bone cutter, Stryker saw or chisel. When properly done, this procedure exposes the entire spinal cord
undisturbed. It can be removed after cutting the spinal nerve trunks.
Large animals: (horses, cattle, etc.) Put the animal in lateral recumbency, preferably after removing the
head. Open the cadaver and remove all internal organs in the usual manner. Reflect the hide, front and
back limbs as far dorsally as possible. Remove the heavy muscles overlying the uppermost aspect of the
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sinus processes of the vertebrae. Using a heavy cleaver or ax, cut away the uppermost lateral vertebral
processes and bodies of the vertebrae to expose the vertebral canal and cord. Remove the cord after
cutting underlying spinal nerve trunks.
3.
Examination of the Bovine Central Nervous System
General comments
Examination of the C.N.S. must be undertaken as an integral part of a thorough, general postmortem
examination, since functional, clinical disorders of the system frequently arise from pathological
processes in other systems. Expertise in exposing and removing the brain and spinal cord in calves and
adult cattle is gained with repeated practice, and the CNS should not be neglected in any necropsy
examination. Tissues of the CNS undergo autolysis fairly rapidly in warm weather. Therefore, for the
most satisfactory results, necropsy examination must be undertaken promptly after the animal's death.
However, certain lesion processes (e.g.: supportive meningitis, brain abscess, cerebral infarcts, etc.) can
be readily identified even in the autolyzing carcass, and the presence of autolysis does not justify a
neglect of this examination.
Removal of the brain
The head is removed by a ventral approach to disarticulation of the atlanto-occipital joint and severance
of the spinal cord. Joint capsule, articular surfaces and synovial fluid are evaluated for evidence of
malformation or arthritis. The physical character of cerebrospinal fluid (CSF), released as the spinal
dura in transected, may be observed and, in freshly dead animals, a sample of the fluid can be obtained
by aseptic puncture of the spinal dura. Particularly when blindness or impaired vision has been a part of
the clinical syndrome, one or both eyes should be removed by enucleation of the globe from the orbit,
using only adnexal tissues for traction, and by severing the optic nerve as far behind the globe as
possible. Orbital tissues and extraocular muscles must be carefully trimmed from the globe and optic
nerve prior to placing them in fixative solution.
The head is skinned, its muscle and ligament attachments trimmed (particularly from the occipital crest
and region of foramen magnum), and the head placed on a solid surface. Individuals may have
preferences for the use of ax, cleaver, hatchet or saw for exposure of the cranial contents, and
an effective technique may be developed by practice with any of these instruments. The hatchet is, in
general, the most practical when assistance is not available, except in the case of mature bulls (cleaver)
or very young calves (saw and/or bone forceps). The head is held on end by the muzzle, with the
foramen magnum and cranial base pressed firmly to a solid surface. By a vertical, glancing chopping
action of the hatchet blade, frontal sinuses are exposed, beginning just behind a line joining the orbits,
and the calvarium and occipital crest removed to leave the dorsal surface of the cranial dura intact. With
the muzzle lowered and the long axis of the head horizontal, deep and 45°-angled strokes are then made
with the toe of the hatchet on each side of the cranial base through occipital bone to the foramen
magnum. The separated occipital bone plate is gently prized away to expose the dura covering the
cerebellum and medulla. To remove the brain with a saw, the first cut is made transversely just behind
the postorbital processes. Right and left cuts are then made starting at the medial edge of the occipital
condyles and extending forward (laterally enough to remove the brain) until they intersect the first cut.
A critical part of the procedure is now undertaken in which particular care is called for from the
prosector. First, using scissors or scalpel, the dura is removed from the dorsal and lateral surfaces of
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each cerebral hemisphere and the anterior part of the interhemispheric falx cerebri grasped with forceps
and cleanly severed. The dura covering the medulla and cerebellum is then incised and removed. Only
the substantial fibrous band of the tentorium cerebelli, now holds the brain within the cranium. It is cut
through with scissors dorso-ventrally, close to its lateral attachments to cranial bone, and carefully
removed together with the already severed trunk of the falx cerebri.
The brain is now ready to be taken from the cranial cavity. The head is tilted backwards on its base
during the ensuing steps, and the angle of tilt progressively adjusted to permit the brain to come to lie
upside down on a moistened pad of paper towels as it is released by the transection of cranial nerve
trunks. The olfactory processes are first cut close to the cribriform plate with a scalpel. The optic
nerves are then severed close to their foraminae, and the infundibular stalk of the pituitary transected.
Finally, the bilateral roots of remaining cranial nerves are individually cut as they become exposed from
front to back. It is important not to grasp, press, squeeze or handle the tissue of the brain during any
stage of its removal. Flowing water should not be used to wash the brain's surfaces, and the organ must
not be scraped with the blade of a knife or cut in an irregular manner.
In cattle, blood supply reaches much of the brain by way of the intracranial rete (rete mirabile), which
lies beneath the dura of the cranial floor, investing the body of the pituitary gland. Septic embolism,
thrombosis and vasculitis of the rete occurs in a number of diseases. The vessel complex may be
removed for fixation by incising through the dura lateral to the trunks and ganglia of the trigeminal
nerves, severing these nerve trunks anteriorly, and "shelling out" from the cranial floor a wedge of tissue
which includes a sheet of dura, both trigeminal trunks and ganglia, the pituitary, and the cerebral rete
with its emergent vessels. The ganglia (semilunar or Gasserian) are particularly valuable to a diagnostic
laboratory when rabies or Aujeszky's disease is suspected.
Removal of the spinal cord
The spinal cord represents a considerable proportion (about 40% by weight) of the bovine central
nervous system and cannot safely be ignored in the investigation of a bovine neurologic disorder.
Rabies, Aujeszky's disease, sporadic bovine encephalomyelitis, thromboembolic
meningoencephalomyelitis, direct trauma and lymphosarcoma are examples of disease processes that
may have significant, primary or secondary organic effects upon the bovine spinal cord. Although it is
often not practical or necessary to remove and examine the entire cord, it is a relatively simple matter to
obtain a useful sample of the thoraco-lumbar region by a few strokes of an ax or cleaver upon the
vertebral bodies in a plane parallel to the long axis of the vertebral column, until the large spinal canal is
exposed. With practice, little damage is done to the cord, which may then be severed, grasped by the
spinal dura with forceps, and removed from the canal together with the spinal nerve roots. When
vertebral fracture, other traumatic injury or vertebral abscess is suspected, attention should be
particularly directed to the level of cord involvement indicated by clinical signs. Epidural tissues of the
vertebral canal may be examined for Hypoderma bovis larvae, as the season, geographic location and
clinical circumstances indicate.
Gross examination of the brain
It is of critical importance to make no irregular, exploratory cuts or slices into the substance of the
freshly removed brain, and to minimize the extent to which it is contaminated, handled or manipulated.
Valuable information can be obtained by the veterinarian if a careful visual inspection of the dorsal and
ventral brain surfaces is made along the following lines:
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a)
Evidence of diffuse leptomeningeal inflammatory reaction: The delicate, leptomeningeal covering
of the brain may show inflammatory hyperemia, evidenced by a filled, bright red appearance of the
finest capillary networks of the pia-arachnoid. Inflammatory exudate of serous, serofibrinous or
purulent character can be identified by slight to moderate excess of clear, faintly cloudy or
yellowish green fluid which accumulates particularly in the deep sulci and between the cerebral
peduncles of the brain base. Extension of the inflammatory process to the choroid plexi and
ventricular chambers may have occurred, in which case the lateral choroids of the fourth ventricle
will be gray and friable and the CSF opaque, turbid or fibrin-containing.
b)
Disproportions and asymmetries: Observe the proportions of the major components of the brain
(cerebral hemispheres, cerebellum, brain stem, cerebral peduncles, etc.) for indications of
hypoplasia, atrophy or apparent enlargement of individual parts. Compare carefully, across the
mid-line of the dorsal and ventral surfaces, the symmetrical proportions of paired structures
(cerebral hemispheres, piriform lobes, optic tracts, cerebral peduncles, cerebellar lateral lobes,
major cranial nerve trunks, etc.). Examination of this kind will detect the presence of such
conditions as hydrocephalus, hydranencephaly, developmental malformations, cerebellar
hypoplasia, pyocephalus, localized cerebral abscess or tumor, and can do so without the necessity
for indiscriminate incision of the brain.
c)
Features of diffuse brain swelling: In such conditions as polioencephalomalacia, salt poisoning,
certain heavy metal intoxications and diseases inducing cerebral hypoxia, the tissues of the brain,
and particularly those of the cerebral hemispheres, assimilate excess fluid and thereby become
diffusely swollen within the rigid confines of the cranial cavity. This is an important feature to
observe grossly at the time the brain is freshly removed, since its presence is more difficult to
establish after the tissue has been fixed or allowed to dehydrate. The presence of brain swelling is
most reliably identified by the effects of displacements produced by increased intracranial
pressure. These effects include a concave rather than a convex surface contour to each lateral
cerebellar lobe, "coning" of a tongue-like portion of the caudal part of the median cerebellar lobe
along the dorsal surface of the medulla (caused by its pressure displacement and protrusion in life
into the foramen magnum), and the presence bilaterally of swollen medial gyri of the occipital
poles of the cerebral hemispheres due to their ante-mortem herniation beneath the edge of
tentorium cerebelli. This latter feature may be associated with venous congestion, infarction
and/or necrosis of these parts, and sometimes also of deep tissues of the thalamus, and may best be
appreciated by gently elevating and spreading apart the occipital cerebral poles for inspection of
their medial surfaces.
d)
Discrete, focal lesions: In the course of the examination already conducted, particular note should
be taken of the location and nature of individual or disseminated, focal alterations of the superficial
tissues of the brain or its coverings. Included among such lesions may be petechiae, ecchymoses,
larger zones of hemorrhage or infarction, single or disseminated miliary abscesses, focal chronic or
granulomatous leptomeningeal thickenings or adhesions, intra-vascular occlusions or thrombosis
of major vessels, foreign bodies, and features of local trauma or reaction related to specific cranial
nerves or tracts.
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Written Case Analysis Format and Objectives
The purpose of the report is (1) to teach future veterinarians to submit concise, accurate and meaningful data
with diagnostic cases, (2) to encourage the habit of careful examination of lesions, and (3) to encourage
students to probe the diseases encountered in depth.
Senior students are required to submit one written report on Friday of each week, and may be asked to present
the case to their peers for discussion. The reports shall be legible, preferably typed. The general format
follows:
1.
History - Only a brief synopsis of the case is needed but it should include any information pertinent to
the differential diagnosis, including clinical pathology laboratory data and treatment that might influence
lesions or culture results.
2.
Description of Findings - Describe concisely the lesions in each organ system in objective terms, in the
present tense, and in complete sentences. Lesions and/or organs should be described in terms of size
(metric system), shape, color, consistency, cut surface, odor, and positional relationships. Each lesion or
abnormality should be summarized in an interpretative conclusion in parentheses. Abbreviations such
as NGL (no gross lesions) may be used when appropriate, but should be defined on first usage.
e.g. "The abomasal mucosa is diffusely reddened (abomasitis) and has approximately 20 crater-like
depressions, 0.5 - 2.0 cm in diameter, each with a dark red base and discrete borders (ulcers).
Negative findings that are important for interpretation of the case as a whole must be included.
3.
Gross Morphologic Diagnoses - List the morphologic diagnoses for each organ system in the order of
their importance as contributors to the terminal disease and/or death. Morphologic diagnoses define the
lesion in terms of nature of the pathologic process or type of exudate, the organ or tissue involved,
distribution or pattern of lesions, and duration.
e.g. a.
b.
c.
d.
4.
Differential Diagnoses - List, in order of probability, the possible diagnoses to be differentiated.
e.g. a.
b.
c.
OR
a.
b.
c.
5.
Chronic diffuse suppurative rhinotracheitis
Chronic passive congestion of the liver
Left ventricular myocardial hypertrophy
Focal disseminated pulmonary neoplasia
Bovine virus diarrhea
Malignant catarrhal fever
Bluetongue
Malignant pulmonary neoplasia
Chronic focal granulomatous pneumonia
Pulmonary coccidioidomycosis
Discussion - This is the important part of the report from a learning standpoint and depending on the
156
case may vary in emphasis. Objectives of the discussion may include one or more of the following:
a.
b.
c.
d.
Correlation of the lesions found with the clinical history, signs and laboratory findings.
Relating the lesions to each other and the various differential diagnoses.
Explanation of the pathogenesis of the lesions including basic information on the disease or
process. Emphasis should be on pathologic aspects of disease and pathogenesis.
Approach to establishing a definitive diagnosis (i.e., what histopathologic findings or other
diagnostic laboratory tests would be required?).
6.
Final Diagnosis - If possible, arrive at a final diagnosis that best fits clinical and pathologic findings.
7.
References - A listing of those textbooks, journal articles and lecture notes that were
consulted in preparing the report should be made. Lecture notes are not acceptable as a sole source of
information, but is the starting point for an in depth search. Always include information that is based on
recent journal articles.
Postmortem Investigation Practicum – Biosecurity Guidelines
Necropsy Laboratory Attire
Students are expected to provide their own coveralls, boots and heavy gloves that extend above the wrist.
Information below is excerpted from the document CSU Diagnostic Lab Procedures (SOP
#FC.PT.Biosecurity.10.02).
Protective Clothing Requirements in The Necropsy Laboratory
A. Areas requiring protective attire.
1. Necropsy room (F103) and adjacent contiguous rooms to the east (F103 A-D and
dedicated prion laboratory area)
2. Walk-in cooler (F102)
3. General tissue trimming and routing room (F101F)
B. Use of protective clothing.
1. General entry for observing only - footcovers required in all areas except F101F.
2. Entry for handling necropsy laboratory equipment (instruments, hoists, cooler door handles
etc) - footcovers and at least latex examination gloves.
3. Handling specimens or necropsies of small animals requiring little physical effort footcovers, laboratory coat or poly apron and latex examination gloves.
4. Routine necropsies - easily cleanable rubber boots, coveralls, and heavy rubber gloves
extending above wrist.
5. Necropsy or handling specimens with potential zoonotic hazard, including prion suspect
material - cleanable rubber boots, coveralls, and heavy rubber gloves extending above
wrist. When aerosals or splashing is expected use disposable, impermeable (Tyvek)
coveralls, arm covers, bouffant caps, eye protection, respirators (high efficiency particulate
filtering equivalent to 3M 8233, adjustable strap, conformable face seal) and face shields as
necessary.
6. When leaving the necropsy floor to go to locker rooms or adjacent lab/office space clean
boots and walk through the foot bath and remove the gloves that were used on necropsy
laboratory floor. Keep door knobs and clean equipment clean. Protective clothing used on
the necropsy floor should not be worn outside of the necropsy laboratory area. This
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includes hats used in the necropsy laboratory. Disposable bouffant caps are available for
those who need hair/head protection. The boundaries beyond which necropsy clothing
(coveralls and lab coats) is excluded are the hallway south of F101F, the hallway west of
the necropsy laboratory conference room (F100), and the north perimeter of the dock area.
C. Students will provide coverall, boots, and heavy rubber gloves.
D. Disposable foot covers, gloves, aprons and foot baths will be at the entryways to the walk-in cooler
and necropsy laboratory. Boots will be rinsed with hot water from a hose in the Necropsy
Laboratory to remove debris from the boot uppers and bottoms before entering the foot bath.
Zoonotic hazards and aerosol containment
In general, PVM students assigned to the postmortem investigation practicum are not expected necropsy
carcasses that represent a zoonotic hazard. The information below is excerpted section from the document
CSU
A. For necropsies of small animals that entail potential zoonotic aerosal hazards, the biological safety
cabinet in Rm. F101B is to be used. These types of cases include psittacosis and plague. Plague
suspects, and especially prairie dogs, should be treated with flea spray is a plastic bag prior to
handling. The external surface of birds should be wetted with detergent solution to contain
feathers and dust. The nervous systems of West Nile virus infection suspects will be examined and
sampled with special procedures for aerosol control.
B. Before beginning the necropsies of animals that are suspected of having rabies, plague,
tuberculosis or anthrax it is necessary to obtain initial samples to rule out the zoonotic hazard
before the main part of the necropsy is begun. For rabies suspects, carefully remove the brain and
submit part for the FA test. For plague, tuberculosis or anthrax submit a smear of
abscess/cellulitis, granuloma, or peripheral blood for gram or acid fast stain. Bag and label the
carcass as a hazard, and place in the cooler. If test is positive do not necropsy unless there special
circumstances. Dispose of the carcass by waste reduction digestion.
C. Necropsies of cases that represent a potential zoonotic hazard require the use of coveralls, gloves,
arm covers, respirators (high efficiency particulate filtering equivalent to 3M 8233, adjustable
straps, conformable face seal) and face shields as necessary. A464N solution will be used to
disinfect instruments and the necropsy area after completion.
D. Potential prion disease cases should be treated as zoonotic hazards even though such status has not
been demonstrated for transmissible spongiform encephalopathies in North America. Procedures
for these cases are performed in room F101A and the dedicated prion laboratory area. Dedicated
instruments must be used and not removed from these areas. Use of protective clothing (I.B.5) and
clean up (II.F) procedures are indicated above.
Parasitology
Sample Submission
All samples submitted to Parasitology for analysis are to be taken to Diagnostic Lab Sample Receiving.
Consulting with the parasitologist is encouraged if there are special requests or questions about the sample or
test to be performed. Submission of samples directly through the Sample Receiving office will allow the
accession to be created in the system faster and results to be input quicker compared to dropping samples
directly off at Parasitology.
Each sample submitted must be accompanied by the General Sample Submission Form. This is a 2-page
form. The first page is general information page and has a place to be stamped with the client blue card. The
name of both the clinician/resident and student must also be entered where indicated on the form. Please
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ensure that the stamp is readable; if not, then hand enter the information in the appropriate sections on the first
page. The second page is the test request page. Check the box next to the test(s) requested. If needed, the
sample submission form can be downloaded from the Forms section on the Diagnostic Lab website:
http://www.dlab.colostate.edu/webdocs/services/index.htm. Click on Main Accession Form.
Tests
Sample requirements for each test offered by the Parasitology service and expected turn-around time is listed
in the Parasitology section of the Test Schedule on the Diagnostic Lab website:
http://www.dlab.colostate.edu/webdocs/services/testschedule.htm.
Some general sample requirements are:
Fecals:
 Equine and food/fiber animals: Quantitative egg counts are standard for all. A minimum 3 gm sample
is best. Collect feces from the rectum whenever possible. Samples can be collected after defecation;
however, ensure that as little soil or other material is collected as possible and do not collect if the
sample is over 6-8 hours old (cool day) or is frozen. Store cool (e.g., refrigerator) until submitted
 Companion animals: Qualitative fecal exams are standard for all. Avoid fecal loops unless there is no
other way to collect a sample (e.g., diarrhea). For normal feces. a minimum 3 gm sample is best.
Collect immediately after defecation, taking care to eliminate as much soil or other material as
possible. Store cool (i.e., refrigerator) until submitted. For Fecal Screen requests, additional feces is
required (6 gm if possible; if not possible, please consult with the parasitologist).
Tritrichomonas foetus
 Bulls: this is regulated by the state of Colorado for animals within and entering the state. Always
make sure to check the current version of the rules or consult with the parasitologist if there are any
questions.
o Smegma – submission using the In-Pouch® is preferred. Samples must reach the lab within 48
hours of collection. Samples may also be submitted in LRS; however, samples must be handcarried to the lab within 24 hours of collection.

Cats: culturing of cat feces for T. foetus requires submission of FRESH, preferably diarrheic, fecal
sample. Trophozoites die quickly, so timely submission is essential. Trophozoite survival can be
enhanced by 1) removing as much litter as possible and/or 2) diluting feces with normal saline by
mixing 2 parts feces with 3 parts normal saline.
Virology Section
Laboratory diagnosis of viral infections is based on three general approaches:

Microscopic examination of infected tissues for pathognomonic changes

isolation and identification of the virus or detection of viral antigens in tissues

significant rise in antibody titer to a given agent during the course of the illness. All of these
methods are carried out in the Diagnostic Laboratory; depending on the virus or suspected viral
disease, one or all of these approaches may yield the specific information desired.
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Because of the nature of virus (and chlamydial) infections a few generalities can be made regarding their
detection. Viruses and chlamydia are obligate intracellular parasites and therefore they are best
recovered live from fresh living tissue. The agents are often recovered or detected only during the acute
phase of the disease. Specimens from which the agents are recovered include throat or nasal swabs,
feces, exudates and visceral organs, but the best specimens are those which are directly affected by the
agent. Many of the agents are very fragile and virological work-up must begin promptly after obtaining
the appropriate specimens, thus rapid transport to the laboratory is important. After the acute phase of
disease, recovery or detection of antigen is rarely accomplished and diagnosis must rely on serological
tests. Serological evidence of infection may be the only approach in some cases, but is still extremely
useful in confirming the relevance of a viral isolate. Thus, both serology and direct detection should be
used together in reaching a diagnosis.
Submission of Specimens
All specimens submitted to the laboratory must be accompanied by a properly filled out viral request
form. The relevant history and source of specimen must be included and, if possible, suspected
diagnoses. Requests for specific tests should be filled out on the request form -or- if unsure of what to
request, the laboratory personnel should be consulted. Also, consult the following : Guide for
Submission by Viral Disease. A request for "viral studies" with no clinical history cannot be accepted.
Specimens for Viral/Chlamydial Isolation or Viral Antigen Detection
Specimens should be taken during the acute stage of the illness and from the affected tissue or lesion
site. The source and kind of material depends on the disease and is outlined below. Tissue or fluid
specimens should be fresh, collected as aseptically as possible, placed in individual sealable
containers, and transported to the lab as rapidly as possible. If a limited amount of material is obtainable
and swabs of mucous membranes or lesions are taken these should be placed in viral transport medium
(available from the Virology Laboratory) for preserving the specimen during transport to the laboratory.
Specimens from necropsy or from an aborted fetus should also be collected as aseptically as possible
immediately after the carcass is opened. Depending on stage of autolysis, viral isolation may not be
attempted.
If a specimen is to be prolonged in transit (greater than 1 hour) it must be preserved either on ice or by
refrigeration. If more than 24 hour transit time is necessary, specimens must be kept on cold packs and
sent in sealed containers.
Specimens for Viral Serology
To obtain evidence of viral infection, it is imperative that paired serum samples be submitted. The first
sample should be taken as early as possible during the acute phase and the second during convalescence,
at least 10-14 days after the initial sample. If only the first (acute) sample is submitted to the laboratory
it can be held (upon request) for the convalescent sample before the test is run on both samples together.
If results on only one sample are requested, these will be provided with the notation that they may be of
limited interpretive value.
Many serological procedures require using live cells. Hemolyzed and toxic samples will often destroy
the cells, making the test impossible to read. Serum must therefore be collected aseptically and put into
sterile tubes.
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A few serological tests do require only one serum specimen for evaluation of exposure to the agent.
These are agar gel immunodiffusion tests for equine infectious anemia (EIA), bovine leukosis virus
(BLV), blue tongue (BT), ovine progressive pneumonia (OPP), caprine arthritis and encephalitis (CAE),
and serum neutralization for pseudorabies virus (PRV), and equine viral arteritis (EVA).
In preparing serum samples for submission, at least 10 cc of whole blood should be put into the red top
vacutainer clot tube. The tube can then be held at room temperature while clotting takes place or
transported immediately to the laboratory. If the sample(s) cannot be transported to the lab on the same
day that it is drawn, the tube(s) should be centrifuged after clotting and the serum removed. If no
centrifuge is available, the serum should be removed from the clot. The samples should then be stored
on ice or in a refrigerator. All tubes must be clearly labeled with identification of the animal and the date
it was drawn. A minimum 1 cc of serum is needed per test requested.
Specimens for Electron Microscopic Examination
Specimens for electron microscope scan include feces, vesicular lesion material, tracheal washes and
nasal swabs. Nasal swabs must be submitted in viral transport medium. These should be collected
during the display of acute symptoms and brought to the laboratory promptly.
GUIDE FOR SUBMISSION OF VIROLOGY SPECIMENS
Specimen(s) to be submitted
History of This
Type of Infection
Respiratory
Antemortem
Postmortem
Nasal swab, pharyngeal swabs,
trachea,lung, bronchial
tracheal wash, paired sera
Lymph Node
Enteritis/Scours
Fresh Feces
Tied loop of intestine,
mesen. Lymph Node
Reproductive
Vaginal swab, Genital
discharge
Fetus and placenta,
fetal lung, liver, kidney,
paired sera
Mucosa/Skin lesions
Lesion biopsy
Vesicle fluid, scrapings
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Joint disease
Joint fluid
Joint fluid, synovial
membrane
CNS/neurologic*
Unclotted blood, CSF
paired sera
Other (specify)
Affected tissue
Brain, CSF
*Rabies: head only
SPECIFIC GUIDE FOR SUBMISSION FOR VIRAL DISEASE
Disease/Viral
Infection
Specimen(s)
Lab Tests
Bovine
Bovine Viral
Diarrhea (BVD)
Nasal swab, feces, unclotted blood,
intestine, esophagus spleen, LN
fetal liver, lung, kidney, placenta
Paired sera
VI, ELISA (blood)
FA,VI
FA,VI
SN
Infectious Bovine
Rhinotracheitis
(IBR)
Nasal, conjunctival swabs, lung,
trachea, fetal lung, liver, kidney
placenta
Paired sera
VI
FA,VI
FA,VI
SN
Respiratory Syncytial
(BRSV) and
Parainfluenza
virus, Type 3
(PI-3)
Nasal swab,
lung
Paired sera
VI
FA, VI
SN, HI
Chlamydial
abortion
Placenta, spleen
fetal liver, spleen, kidney, lung
FA
Blue Tongue (BT)
1 ml. serum
5 mls. hep. blood (Green Top)
AGID
VI
Bovine Leukosis
1ml. serum
AGID
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Bovine Coronavirus
and/or Rotavirus
(calf scours)
Vesicular Stomatitis
(VSV)
Bovine Mammalitis
Pseudocowpox
Disease/Viral
Infection
Feces
Intestine, colon, tied segments
EM, LA
EM, FA, LA
Vesicular fluids, deep swabs of lesion,
or biopsy or exudate
Paired sera (VSV)
FA,EM,VI
Specimen(s)
SN
Lab Tests
Equine
Rhinopneumonitis
(ERV, EHV-1, EHV-4)
Nasal swab, trach.wash
fetal lung, kidney, liver,
brain, CSF, unclotted blood
Paired sera
PCR
PCR
VI
SN
Influenza (EI)
Nasal swab, tracheal wash, lung
Paired sera
ELISA
HI
Viral Arteritis
Serum
SN
Equine Infectious
Anemia (EIA)
1 ml. serum
AGID
Eastern/Western
Viral Encephalitis
Brain, spinal cord
Paired sera, CSF
VI-sent to NVSL
CF, HI (sent to
NVSL)
Chlamydial
Pneumonitis/Enceph
Trach.wash, lung brain
FA
Rotavirus
Intestine, feces
EM, LA
Vesicular
Stomatitis (VSV)
Vesicular fluids, deep swab
paired sera
VI
SN
Ovine, Caprine
Chlamydial
Abortion
Placenta, liver, spleen
Blue Tongue (BT)
See Bovine BT
Ovine Progressive
Pneumonia/Caprine
1 ml. serum
FA
AGID
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Arthritis and Encephalitis
Porcine
Transmissible
Gastroenteritis/Rota virus
Feces, intestine, tied segments
EM,FA,LA
Specimen(s)
Lab Tests
Paired sera (TGE)
Lung, tonsil, brain
Single serum sample
SN
FA, VI
SN, LA, ELISA
Placenta, fetal lung liver, spleen
Paired sera
FA, VI
HI
Serum
ELISA
Nasal swab, lung, trachea
Serum
ELISA
HI
Panleukopenia (FPV)
Feces, intestine
EM, ELISA
Feline Rhinotracheitis(FVR)/
Calicivirus
Nasal, pharyngeal and conjunctival
swabs, lung, bronchial LN
VI, FA, PCR
Chlamydial
Pneumonitis
Nasal, pharyngeal and conjunc. swab
FA
Leukemia/
(FeLV)
0.5 ml serum
ELISA (Ag)
Feline Immunodeficiency virus
(FIV)
0.5 ml serum
ELISA (Ab)
Feline Infectious
Peritonitis
Paired sera
IFA
Disease/Viral
Infection
(TGE/Rota)
Pseudorabies
Porcine
Parvovirus (PPV)
Porcine Reproductive and
Respiratory Disease Virus
(PRRS)
Swine influenza
Feline
164
Canine
Parvovirus (CPV)
corona/rotavirus
Feces, intestine
Paired sera
EM, ELISA
HI
Disease/Viral
Infection
Specimen(s)
Lab Tests
CSF, conjunctival scrapings, nasal swab,
unclotted blood, brain, lung
Paired sera
Nasal swab, urine, lung, liver, kidney
serum
FA
Genital lesion swab, uterine biopsy,
placenta, fetal lung, spleen, liver
serum
VI
Nasal swab, lung, trachea
serum
VI
HI
Distemper (CDV)
Infectious canine
hepatitis (ICH)
(CAV-1)
Canine Herpesvirus
(CHV)
Laryngotracheitis
(CAV-2)
SN
VI
HI
SN
G. Medical Record Department
Filing System
Medical records are filed numerically in terminal-digit order. With the terminal-digit system a medical record
number (i.e. 048321) is broken down into three sections:
20
83
21
3rd
section
2nd
section
Primary
section
When looking for a record, go to the primary section first. These are the color-coded numbers. Within each
primary section, groups of records are matched according to the digits in the 2nd section. After locating the
correct secondary digit section, the chart is filed in numerical order by the digits in the 3rd section. Note the
following sequence in a terminal digit file:
08-83-21
09-83-21
10-83-21
10-84-21
20-84-21
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After-Hours Retrieval of a Medical Record (animals with previous admission)

Obtain patient number from client account in computer. See the Computer Section of the Procedures
Manual for information regarding logging on to the computer. This will list all of the animals for a
particular client, whether large or small animals. The case number will be listed with the animal‟s
name.

Look on the computer to find the location of the record. Instructions are available beside the terminal
in Medical Records.



o
If the record has been checked out, the computer will indicate its location. If the record is not found
in that location, check the coding and abstracting designated areas.
o
If there is a return date on the checkout section in the computer, this indicates the record has been
re-filed and should be in the main files. Also, if the computer indicates no checkout history exists,
check in the main files.
o
If the computer indicates (at the bottom of the screen) that the record has been archived/scanned,
read the section on viewing scanned/archived documents as to how to access archived records.
Fill out a Medicals Records “Checked Out To” slip.
You must include all information.
Go to main file/indicated location and remove chart.
o
o
Small animal charts are the left 3 aisles of main file.
Large animal charts are in the 4th aisle of main file.

If record is found, leave outslip in the basket labeled "outslips".

Students may remove charts for study. However, we ask that they be returned within one week and
that medical records are not removed from the hospital.
DO NOT REMOVE ANY CHART WITHOUT FILLING OUT AN OUTSLIP!
DO NOT REMOVE CHARTS FROM HOSPITAL!
Computer Retrievals
Computer Retrievals for retrospective study of specific diagnoses and/or operations, statistics, etc. are
available through the medical record department. Contact Anne Deshon at x360 in Medical Records, for
further information.
Release of Information Policies

The medical record consists of any printed document of the diagnosis and treatment of animals at the
Veterinary Teaching Hospital, whether hard copy or computerized. Billing information,
correspondence, and/or records from other institutions are not part of the legal medical record.
166

The medical record itself is the property of the Veterinary Teaching Hospital. However, the
information contained in the record belongs to the client. Therefore, the client must authorize the
release of this information.

When a veterinarian is listed by the owner as the referring veterinarian, the owner implies
authorization for he/she to access the medical information necessary for continuing medical care.

The attending clinician will be notified when a record is being released and will have an opportunity to
review the record before it is released. In the absence of the attending clinician, the section chief or
Hospital Director will be notified.
The only information that can be released without the owner's signed authorization is the vaccination
status, neutering status, and discharge instructions.


Students and staff may access records only as needed in performing their function at the VTH. The
information contained in a medical record is confidential and can only be released by medical
records personnel.

A letter from a patient's owner directing the hospital to release certain information to a specified
recipient will suffice as proper authorization and will be honored by medical records.

If the animal was previously treated under another owner, the original owner must sign a "Change of
Ownership" form before information may be released. This form suffices for all future releases under
the second owner's authorization.
A photocopying charge will be assessed on any records that are released for reasons other than
continuing medical care (i.e., clients, insurance company, and attorney).


A charge will be assessed on all faxes regardless of reason.

On legal request (i.e., subpoena), a certified photo copy of all or part of the medical record will be
provided to duly authorized person. Original records will be retained by the Hospital in all cases,
unless a court order specifically directs the Hospital to submit the original record to the court.
Viewing Scanned Archived Documents
Scanned/archived can be accessed on the computer via the VTH Homepage. At the VTH Homepage, click on
VTH Patient Information and list the case number and hit enter. Click on an invoice number listed (these will
be in blue), which will then go to the Patient Information – Invoice Details screen. At this point, click on the
type of scanned image desired – either anesthesia or archived. In either case, a scanned image will pop up and
can be advanced to other pages by using the arrow buttons at the top of the image. Any of these scanned
images can be printed, although they should not be removed from the premises of the VTH without the
owner‟s and Medical Records permission, so as not to violate confidentiality laws.
H. Pharmacy
Inpatient
General. Most items issued by the pharmacy are dispensed by prescription only. In some areas,
arrangements have been made for replacement of stock (unique or urgently needed items) through
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prescription orders received afterwards (See "Stock for Other Areas" section). A few inexpensive common
use items are stocked in treatment areas and not charged to individual patients.
Initial Drug Orders
The pharmacy issues on prescription a small quantity of drugs for a particular patient. A maximum of one
week's supply will be dispensed to inpatient client animals. Students may write these prescriptions but a
veterinarian must countersign them. Included on the prescription should be the following: client's name,
species, case number (all from embossing card), date, drug name, strength, dosage form, dose, quantity
desired, weight of animal and student signature if written by such.
Occasionally an animal will be scheduled to be sent home after only a few inpatient doses are given. In this
case, the request should be marked in the appropriate blank, patient status "inpatient," label for "outpatient
use." This will insure that the order is labeled and charged appropriately. A drug profile for each patient will
be maintained on the computer.
Refill Orders
Refill requests are to be prepared in the same manner as the initial request except that a clinician signature is
not required. If there is any change such as route of administration, dose, frequency, a clinician's signature is
required.
Discharges
Inpatient orders differ significantly from outpatient prescriptions. Discharge prescriptions require outpatient
labeling and are to be dispensed accordingly. Inpatient orders may be filled by non-pharmacists and require
only limited labeling. Outpatient prescriptions must be filled by a pharmacist and include the following
information on the label: date, transaction number, client, species or animal's name, adequate directions for
lay use, name of drug and clinician's name.
When an animal is to be sent home, the student should bring all unused medication to the pharmacy for
credit. NO MEDICATION IS TO BE SENT HOME UNLESS IT IS RELABELED FOR OUTPATIENT
USE. The pharmacy will re-label medication to be sent home, but this requires a new signed prescription.
Outpatient Orders
VTH Client Animals
Outpatient prescription orders are required when medication is to be sent home with the client. This may
occur for routine outpatients, patients being discharged or clients picking up
medication for their
animals. These prescriptions may be filled at the VTH pharmacy or at a local pharmacy. Note: According to
state law, veterinarians not licensed in Colorado may not write prescriptions to be filled at pharmacies
outside this institution. They may, however, call-in prescriptions giving their mentor's name and license
number. The pharmacy may ask for a DEA license number in which case you may give the hospital number
with your suffix; or they may require a clinician, (license, name and #'s) who have DEA numbers and are
licensed in Colorado. (Available from the Pharmacy)
Requests from non-VTH Clients or Veterinarians
Pharmacy Sales Policy - Federal legislation (Robinson-Patman Act and the Prescription Drug Marketing Act)
have necessitated the following policies:
168

The VTH Pharmacy will fill prescriptions issued by private (non-CSU) practitioners as long as the
client has a valid CSU account number.

The VTH Pharmacy is prohibited from selling any item directly to a private practitioners, business or
any other non-state agency except in an emergency.

All walk-in sales will be restricted to authorized clients during regular Pharmacy hours. After-hours
only a small emergency supply (72 hrs) may be issued.
Stock for Other Areas
Supplies for CCU, Ambulatory, Surgery Areas, etc. may be obtained from the Pharmacy by indicating the
items desired on a general purpose prescription blank. These orders do not require clinician‟s signatures.
Replacement items may be obtained by the unit and charged to a particular patient directly rather than the
unit. This may be done by stamping the order with the patient's card and marking it "For Replacement."
Controlled Substances (see also After-Hours)
General
The Controlled Substances Act and its implementing regulations require that complete and accurate records
be kept of all transactions involving controlled substances. Cooperation is therefore essential in accounting
for these drugs. Failure to comply with established procedures may result in investigation and reprimand by
outside enforcement agencies.
Controlled substances are available primarily on prescription from the Pharmacy or from the Pyxis
machines. Some controlled substances are still available from areas such as Large and Small Animal
Anesthesia, Student Surgery, etc. Whenever items are withdrawn from one of these outlying storage areas, it
is essential to account for such through the corresponding log sheet.
Only approved operators (clinicians and selected technicians) may acquire drugs from the Pyxis. The senior
students must ask a technician or clinician to obtain a controlled drug from the Pyxis machine after hours for
wards and CCU patients. Proper documentation must appear in the record for the student to obtain these
drugs.
Specific procedures are established for operators of this machine. Whenever, controlled substances are
removed from the Pyxis, a Controlled Drug Disposition Record is to be used and placed in the patient's
medical record to account for use and/or waste of the item taken. This record sheet is not required for those
items recorded by Anesthesia personnel on their forms or for euthanasia solution recorded on the Euthanasia
form provided the volume administered is noted.
Controlled substances obtained from the pharmacy by written prescription for individual outpatients are kept
in the pharmacy during the day and transferred to the (after hours drawer) in the Pyxis for client picking up
animals after pharmacy hours.. (Note: Orders for schedule II substances cannot be altered and must be
rewritten if change is necessary.) Prescription requests for Schedule II substances may include requests for
other inpatients orders. However, outpatient prescription requests should be on a separate order form as nonscheduled outpatient prescriptions must be filed separately from Schedule II prescriptions.
All unused controlled substances in their original packaging obtained from the Pyxis should be returned to the
169
Pyxis. Partials should be wasted and recorded on the Disposition Record form. Unused controlled substances
obtained from the Pharmacy may be returned either to the pharmacy (during regular hours) or placed in the
Pyxis return drawer (after-hours). Under no circumstance should unused controlled substances be held for use
on a different patient!
Thiopental
Thiopental is being used on both large and small animals. However, the strength used on large animals is
10% (100 mg/ml), whereas, a 2.5% (25 mg/ml) is employed for small animals. On rare occasion one may
find a different strength solution being used elsewhere in the hospital for a unique situation. Therefore, make
certain of the strength of the thiopental before administering.
Stock Held in Outlying Areas
Each area is responsible for accurate records, storage and security for controlled substances kept for use by
their service. The empty container and corresponding completed deposition sheet must be returned to the
pharmacy to obtain replacement stock.
After-Hours
Authorized Entry
The Colorado State Board of Pharmacy Rules and Regulations section 5.01.50 (Security) expressly prohibits
the entry of a locked licensed pharmacy by persons other than a licensed pharmacists except for bona fide
circumstances by authorized individuals. For the Veterinary Teaching Hospital Pharmacy, authorized
individuals are clinic faculty, selected staff and senior students.
University auditors also have concern regarding pharmacy security. Therefore, bona fide circumstances have
been defined as:

Need to obtain medication or items to treat a particular hospitalized patient or outpatient seen on
emergency

Need to obtain pharmacy supplies for a treatment area or ambulatory vehicle.

Need to acquire hospital related drug or prescription information.
All after-hour entries into the Pharmacy must be documented. Documentation is most easily done by
leaving a signed pharmacy request form (written prescription order) for the items removed. Please indicate
the time of entry on the request form by your name. When not obtaining items and thus not leaving a request
form, the Reason for After-Hour Entry form must be completed. Pharmacy personnel will review after-hour
entries on a daily basis.
Do not enter the Pharmacy after-hours to obtain items for personal needs such as aspirin, boxes, pet food, ice
packs, etc. Never allow non-hospital personnel into the Pharmacy after-hours.
Charges
Outpatient. Locate item in the price book to obtain unit price. Price all prescriptions at the full selling price,
as indicated. Minimum price is $5.75 per prescription item. There is a $2.75 labeling fee added to the drug
price. The original prescription order is to remain in the Pharmacy. The yellow copy may be kept with the
Business Office documents.
170
Inpatient. There is no need for these orders to be priced. Just make certain that the item, strength, quantity,
dosage form, and other information is adequate for the pharmacy to charge later.
Discharges. For prescriptions not already included on the patient's final invoice, price as described under
outpatients (#1) and add to final bill.
Controlled Substances. New issues of controlled substances needed after hours may only be obtained from
the Pyxis by authorized operators. Federal law prohibits the transfer of these drugs to any patient other than
the patient for which it was prescribed.)
Emergency Pharmacy Items
On rare occasion a non-formulary item (or item the pharmacy is currently out of may be needed in an
emergency to treat a patient. Please make every effort possible to contact a VTH pharmacist to make
arrangements. For small animals, if one of the pharmacists cannot be reached, one of the CCU faculty
clinicians may authorize emergency supplies from Poudre Valley Hospital. The VTH Hospital Director or his
Assistant should be contacted as a last resort for small or large animal emergency needs.
Outside Sales Requests
No sales are to be made for animals not currently in the hospital. Sales directly to outside veterinarians can
only be for emergency situations (limit supply to 72 hrs). Authorization for such sales should be made after
contacting one of the pharmacists or the Hospital Director.
Miscellaneous Information
Items for Personal Use. Because of the high demand for pharmacy services on weekends and the limited
coverage available, requests should be limited to essential needs. Dropping personal orders off at the
pharmacy and returning later to pick it up is greatly appreciated. Since the highest demand for pharmacy
service usually occurs between 4:00 and 5:00 p.m., please avoid placing personal requests during this period.
Reusable Items. Fluid containers should be rinsed thoroughly after use and placed in designated areas or
receptacles for final cleaning and reuse. Disposable needles are to be discarded in the specifically designed
receptacles and not thrown in the trash.
171
VII: Appendix Forms
Hospital Forms, Memos and Policies
Accepting Money After Hours/Emergency Procedures ............................................173-174
After Hours Forms .....................................................................................................175-178
Animal Bite Form ......................................................................................................179
Approved Cage Card .................................................................................................180
Building Safety Plan ..................................................................................................181-195
CSU Discount Policy .................................................................................................196
Care Credit ................................................................................................................. 197
Children at the VTH ..................................................................................................198
Client Management Recommendations .....................................................................199-200
Clinical Pathology Research Support and Cytology Services Memo........................ 201-202
Companion Care Fund Request Form .......................................................................203
Consent for Surgery ...................................................................................................204
CSU VMC CPR Directive ......................................................................................... 205
Dismissal Form ..........................................................................................................206
Euthanasia/Postmortem Cremation Releases............................................................. 207
Fee Estimate ...............................................................................................................208
Financial Information ................................................................................................ 209
Hay Shed Cleaning Procedures/Protocol ...................................................................210
In-Depth Cleaning......................................................................................................219-229
Floor Plans ................................................................................................................. 211-214
History/ Exam Forms .................................................................................................215-217
In Depth Cleaning Procedures Using Virkon ............................................................ 218-230
Master Problem ..........................................................................................................231
Outpatient Day Fee ....................................................................................................232
Parasitology Diagnostics Laboratory Form ............................................................... 233
Progress Notes ...........................................................................................................234
Referral For (Patient Referral Information) ............................................................... 235-236
Sharps Handling Policy & Procedure ........................................................................237-239
Stall Card ................................................................................................................... 240
Transfer of Ownership / Referring Veterinarian........................................................ 241
Unrestricted Donation Form ...................................................................................... 242
VTH Dress Code ........................................................................................................243-245
VTH Referral Policy ..................................................................................................246
PVM Forms, Memos and Policies
Equipment and Apparel Requirements ......................................................................247
PVM Class Attendance .............................................................................................. 248-251
PVM Excused Absence Request Form ......................................................................250
PVM Independent Study/Approval Form ..................................................................251-256
Student Evaluation .....................................................................................................257
172
ACCEPTING MONEY AFTER 10:30 PM
Payments for fees and estimates may be accepted in 3 different ways:
CASH OR CHECK:
1.
2.
3.
Write out a cash receipt including the client’s name, case number and amount of payment. Please make a note on the
receipt if the name of the person paying is different from that on the record.
Give the client the white copy
Place the cash or check and the yellow copy of the receipt in a clear envelope (found in the drawer below the forms
wall) and drop it in the Night Deposit Box on the wall next to the business office.
CREDIT CARD:
1.
2.
3.
4.
5.
We accept Visa, Master Card, Discover, and American Express.
Instructions on how to use the credit card machine are posted on a laminated card next to the credit card machine
(which is located by the blue card stamper).
Write out a receipt including the client’s name, case number and amount of payment. Please make a note on the
receipt if the name of the person paying is different from that on the record.
Give the client the white copy of the written receipt and the client copy of the credit card receipt.
Place the merchant copy of the credit card receipt and the yellow copy of the written receipt in a clear envelope and
drop it in the Night Deposit Box on the wall next to the business office.
CARE CREDIT:
1.
2.
3.
4.
If the client already has a care credit account, write the account number, name, case number and amount on the care
credit slip. You MUST have the client sign the slip.
Write out a receipt as in #3 above.
Give the client a white copy of the receipt.
Put the yellow copy and the entire care credit receipt in a clear envelope and drop in the Night Deposit Box on the wall
next to the business office.
If the client wants to apply for care credit, go to www.carecredit.com and follow the instructions. If they are approved,
follow the above steps to take payment.
173
AFTER HOURS EMERGENCY PROCEDURES
1. Fill in all the information on the blue emergency sheet. Please note the
time of day as A.M. or P.M. Leave the blue sheet with the “After Hours
Admission Log Book” on the small animal reception desk closest to the
door.
2. Have the client sign the blue “Admission Authorization and Consent
Form”.
3. All animals must be logged in the notebook labeled “After Hours
Admission Log Book” for small animals or the red log book by the blue
card stamper for large animals.
4. Be sure to give the client the tan sheet which states the hospital
financial policy information.
174
175
176
177
178
179
180
VETERINARY
TEACHING
HOSPITAL
BUILDING
SAFETY PLAN
181
TABLE OF CONTENTS
Emergency telephone number
page 3
Notification tree
page 3
Weekend and night emergency procedures
page 4, 5
Phoning CSU police with an emergency
page 6
Evacuation plan
page 7
Fire/smoke procedures
page 8
Hazardous material spills
page 9
Special areas/Detailed hazardous material list
page 10
Earthquake
page 11
Flood/water damage
page 12
Medical
page 13
Tornadoes and winds
page 13
Other emergencies
page 13
Bomb threat
page 14
Snow emergency
page 15
Safety in offices or classrooms
page 16, 17, 18
Soft target awareness at CSU
page 19
182
VETERINARY TEACHING HOSPITAL
BUILDING SAFETY PLAN
EMERGENCY TELEPHONE NUMBERS
POLICE AND FIRE
911
POLICE (NON EMERGENCY)
16425
DIRECTOR OF THE VETERINARY TEACHING HOSPITAL
DR. DEAN HENDRICKSON
71269
229-9539
420-0697
VTH
HOME
CELL
217-9407
VTH
HOME
CELL
ASSISTANT BUILDING PROCTOR
KATHIE SEXTON
71269
484-7362
420-7015
VTH
HOME
CELL
SAFETY OFFICER
RICK ALLEN
71291
482-2676
VTH
HOME
DIRECTOR OF BIOSECURITY
DR. PAUL MORLEY
70374
219-6089
VTH
CELL
BIOSECURITY OFFICER
DR. BRANDY BURGESS
75150
517-5256
VTH
CELL
ENVIRONMENTAL HEALTH SERVICES
16745
FACILITIES SERVICES DISPATCH
10077
BUILDING PROCTOR
NOTIFICATION TREE
The hospital will utilize the overhead paging system when possible. If it is not in working order, the individuals listed will
notify section heads and area supervisors. Section heads and area supervisors will then notify faculty, staff and
students in their respective areas.
DIRECTOR OF THE VETERINARY TEACHING HOSPITAL
DR. DEAN HENDRICKSON
71269
420-0697
VTH
CELL
HOSPITAL ADMINISTRATOR
GAIL GUMMINGER
71221
420-1795
VTH
CELL
BUILDING PROCTOR
VTH
HOME
183
ASSISTANT BUILDING PROCTOR
KATHIE SEXTON
217-9407
CELL
71269
484-7362
420-7015
VTH
HOME
CELL
WEEKEND AND NIGHT EMERGENCY PROCEDURES
If equipment/facility problems arise during evening or weekend hours, the following people should be
contacted in the order they are listed. Please do not call them unless you do have an emergency.
If calling from within the hospital dial 8 for an outside line. All area codes are 907 unless otherwise noted.
PROBLEM AREA
CONTACT PERSON
PHONE NUMBER
Accidents/Fires/Violent acts/Emergencies
CSU Police/pull wall alarm for fires
911
Non-emergencies/Fire alarm malfunction, etc.
CSU Police
16425
Ambulance
Poudre Valley Hospital
8-495-7000
Air conditioning/heating/electrical/drains/
CSU Facilities Department
10077
plumbing/electrical/medical air/suction
Barns (main barn, isolation, research)
Ken Wayland
225-2046
Jessica Brand
(C) 412-0701
Dr. Paul Morley
(C) 219-6089
Dr. Brandy Burgess
(C) 970-631-6327
Blue card embosser (Rockwest Technologies Group)
Data Card (model 280, serial # 12574)
8-1-888-916-0160
Computer system
Help Desk = 297-HELP
297-4357
Custodial Services/Animal Care
Mike Colleary
227-8183
Biosecurity
Brian Marsden
224-3910
Large animal surgery tables
Jim Flowers
568-9605
Paging system/Medical gases
John Gerwig
(C) 420-8978
These are the only two areas considered to be an
emergency. This does not mean individual pagers.
Pharmacy
Rick Allen
482-2676
184
Prox reader doors
Charleen Becker
686-5549
Paula Morgan
221-0089
Marty Yates
834-1451
Charles Hepner
(C) 631-5459
Main Entrance Door
Steve Drew
(C) 412-8187
Telephones (automated attendant at 10:30 p.m.)
CSU Police ( ask them to page the tech
16425
on call from Telecommunications)
Radiation safety concerns
Joe Tessari
(C) 566-1532
Business Office, Medical Records
Tracy Keegan
493-6790
Business Office, LA & SA Reception, operator,
Anna-Lee Mercado
420-3585
transcription
Snow days: Local radio stations after 6:00 a.m. or the CSU snow hot line 8-491-7669, then people listed below.
People in the above areas are not on call, therefore you may need to leave a message. If people in the above areas
cannot be contacted in a timely manner, or the problem does not fit into any of the above categories
please call the individuals below in the order listed:
Kathie Sexton
Assist. Building Proctor
(H) 484-7362
(C) 420-7015
Gail Gumminger
Administrator
(H) 407-9474
(C) 420-1795
Dr. Hendrickson
Director
(H) 229-9539
(C) 420-0697
2/1/2010
WHEN PHONING CSU POLICE DEPARTMENT WITH AN EMERGENCY
In the event of a fire, smoke, explosion, hazardous spill, toxic leak, releases of flammable or toxic materials, or acts of
nature which potentially endanger the lives of humans or animals in the buildings, the following procedures should be
followed.
PHONE CSU POLICE 911
1.
2.
3.
4.
5.
6.
7.
State your name.
State the purpose of the phone call (police, fire, ambulance needed).
State the location of the emergency, include building address, room # or area.
EXAMPLE: Veterinary Teaching Hospital, Clinical Pathology Lab, Room C104.
State what type of emergency has occurred (fire, chemical spill, etc.).
Indicate if people are injured or trapped.
Provide information on special precautions that response personnel should take. See “Special Areas”
Let the police end the phone call, thus assuring they have all the information they need.
page.
185
EVACUATION PLAN
USE THE NEAREST AVAILABLE EXIT, REFER TO THE FLOOR PLANS FOR POSSIBLE ROUTES.
EVACUATION ROUTES ARE POSTED ON BULLETIN BOARDS IN PROMINENT LOCATIONS THROUGH OUT
THE HOSPITAL. WHETHER YOU INITIATE THE EMERGANCY RESPONSE, OR RESPOND TO THE ALARMS OR
STROBE LIGHTS, FOLLOW THESE EVACUATION STEPS.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Faculty who are teaching classes at the time of the emergency are responsible for the orderly evacuation of the
class and should be the last one out of the room.
Laboratory equipment should be shut down, turned off and/or stabilized. In case the building ventilation,
cooling, etc. is intentionally or unintentionally shut off the equipment will not provide an additional hazard by
overheating, boiling over or exploding, etc.
Turn off all gas and electrical equipment including flame burners and appliances.
DO NOT take time to turn off computers, printers or office lights. Close but DO NOT lock the office door.
DO NOT use the elevator.
Proceed in an orderly manner as quickly as possible to the nearest exit and then to the designated reporting
area. Know an alternate exit route. All personnel should be familiar with the closest exit paths for their areas.
Refer to the floor plans posted in prominent locations through out the hospital.
Everyone should move away from the building to predetermined locations set by your section. The supervisor,
lead worker or section leader is responsible for determining the location to evacuate to.
DO NOT block or obstruct road or parking lot access to the building, which would hinder emergency vehicles,
equipment or personnel.
Stay in the designated reporting area. When everyone has evacuated the building, determine if everyone is
accounted for. IF anyone is missing, notify emergency personnel that someone may still be in the building. DO
NOT leave the predetermined location until authorized to do so.
Whenever an alarm is sounded it is important to take it seriously and evacuate the building.
Silencing of the emergency alarms DOES NOT mean the emergency has been contained or that the building is safe to
re-enter. Alarms are silenced so that emergency response personnel are able to communicate with each other. DO
NOT RE-ENTER THE BUILDING for any reason until instructed to do so by emergency response personnel (fire,
police).
*** Evacuation of animals from an endangered area in the building or barns should be carried out ONLY if human life
will not be threatened. It is important to check with emergency response personnel (fire, police) if there is a question as
to whether animals can be evacuated safely. The fire department or police will be the final authority on this matter.
*** A skeleton crew of necessary personnel may remain in the Critical Care Unit, Large Animal Surgery area, Small
Animal Surgery area and the Small Animal Anesthesia Prep room (to insure the health and safety of critically ill or
anesthetized animals), until they are notified by emergency response personnel to evacuate the building. Fire or police
authorities will make this notification using the intercom system in these designated areas, or in person. Because there
is only an intercom for the Small Animal Surgery area, those personnel are responsible for notifying Anesthesia prep
room personnel of the evacuation signal sent.
*** If you are working with an anesthetized or critically ill animal in another area of the VTH and must continue to
provide care, you must take the animal to one of the designated areas above so that changes in evacuation status can
be communicated.
FIRE/SMOKE PROCEDURES
1.
In case of fire, regardless of size or severity, immediately telephone the CSU Police 911, and/or pull the nearest
186
manual fire alarm box handle. Use the sequence which will take the least amount of time. DO NOT call the
Fort Collins Fire Department as their dispatcher will verify with the CSU Police Department before
responding.
2.
If there is immediate danger, remain calm and follow the evacuation procedures, then call the CSU Police
Department from a nearby building. Call the building proctor. (See emergency telephone numbers)
3.
Follow the evacuation plan. Listen for directions at your designated area.
4.
DO NOT RE-ENTER THE BUILDING.
IF YOU ARE TRAPPED IN THE BUILDING..................
1.
If the door to the room you are in is hot to the touch and/or smoke is seeping in around it DO NOT OPEN IT!!
2.
Remain calm. Walls, ceilings, floors and doors are designed to withstand fire for a safe period of time.
3.
Pack the crack under the door with wet clothing or other material to keep the smoke out.
4.
Let someone know you are trapped. Call 911 and stay on the line until the dispatcher tells you to hang up. If
there are no phones available, yell out the window (if you have one), kick on the door, do any thing to make
noise and draw attention to yourself.
5.
Stay low to the floor as the smoke will fill higher areas first
HAZARDOUS MATERIAL SPILLS
Chemical spills should be handled by trained laboratory personnel working within the section where the
chemical or compound is used. Each laboratory should be knowledgeable on the proper procedures to handle
chemical spills.
1.
Know where fire extinguishers and other safety equipment is housed.
2.
Know what type of fire the extinguisher in the area is rated for.
3.
Most laboratories in the building have CO2 or dry chemical extinguishers that can be used on most
fires.
4.
Do not use water for most laboratory fires.
5.
CO2 extinguishers are best for electrical equipment fires.
6.
Know how to properly use fire safety equipment.
BENCH TOP SPILLS
A bench top spill is defined as; a spill that will not contaminate the water supply, sewer, or any other area and is small
enough to be easily handled by VTH personnel, and there are not any injuries.
1.
Remain calm.
2.
Contain the spill with absorbent pillows.
3.
Consult the Materials Safety Data Sheet (MSDS).
4.
If you are familiar with handling the spilled reagent, obtain the proper spill kit and follow the
directions that
are with the spill kit.
5.
Notify the supervisor/manager of the area.
6.
Notify Environmental Health Services, Department of Hazardous Waste Management, that a spill has occurred.
7.
Dispose of all absorbent pillows according to Colorado State University Hazardous Chemical
Waste Systems Manual.
If you are not familiar with the spilled reagents or you do not feel comfortable cleaning up the spill, follow the
instructions for large spills.
187
LARGE SPILLS
A large spill is defined as: a spill that may contaminate the water supply, sewer, or any other area, is too large to be
easily handled by VTH personnel and there are injuries.
1.
Remain calm.
2.
Only if there is NO IMMEDIATE DANGER; call 911, have the following information available for the dispatcher.
a.
Where the spill occurred.
b.
What was spilled (with the correct spelling).
c.
How much was spilled.
d.
When the spill occurred.
e.
Are there any injuries.
Stay on the line until the dispatcher tells you to hang up.
If there is IMMEDIATE DANGER follow the evacuation procedures and call CSU Police Department from a nearby
building and have the above information available.
ALL LABORATORIES SHOULD BE EQUIPPED WITH SPILL KITS FOR THE APPROPRIATE MATERIALS BEING
USED IN THE LABORATORY. FOR EXAMPLE ACIDS, BASES, MERCURY, ETC.
SPECIAL AREAS OF CONCERN
FOR A COMPLETE LIST OF HAZARDOUS MATERIALS GO TO THE BACK OF THIS BOOK
1.
Computer room
A101
Houses the hospital main frame computer (billing system
and medical records) and a PC with the hospital security
system data.
2.
Pharmacy
A128
3.
Nuclear Medicine
G101C
Radioactive materials
4.
MRI
ACC 156
Large magnet! DO NOT ENTER See their safety protocol
5.
Linex Accelerator
D106C
Need a key code to enter, need a key to get on roof above.
6.
CT Scanner
H106
7.
Radiology
G108
G108 is the main office. Chemicals used in X-rays.
8.
Clinical Pathology
C104
Reagents used in running blood work and other tests.
9.
Critical Care Unit
C103
Critical care of small animals. Oxygen & oxygen cages.
Houses the main drug inventory at the VTH (including
restricted drugs). Autoclave
188
10.
Central Supply
C112
Autoclaves for sterilization of hospital instruments.
11.
Diagnostic Lab
E102-E119
Reagents used in running blood work and other tests.
12.
Foal Care
Barn 104
Critical care of foals. Oxygen used
13.
Isolation Barn
North of VTH
Critical care of large animals. Infectious animals. Oxygen used.
14.
Necropsy
F102-F103
Formalin and other chemicals used in necropsy.
15.
Oncology
C118
Chemicals used for oncology treatments.
16.
Oxygen tank
North of barn
breezeway
Piped into the hospital and barns. 1500 gal. tank
17.
Nitrogen tank
North of barn
breezeway
Piped into the hospital and barns. 3000 gal. tank
EARTHQUAKE
1.
2.
3.
4.
5.
6.
7.
8.
9.
Take cover under heavy furniture - a table, desk or bench, or within a doorway.
Keep away from glass.
Wait for quake or tremor to subside and all falling objects to come to a rest.
For small quakes or tremors with NO apparent damage, return to normal activities. Building proctors will survey
the entire building for possible damage such as: leaking pipes, fallen blocks, etc. Proctors will meet in
designated areas to report damage to CSU Police.
Remain calm.
If damage appears heavy, evacuate ONLY when notified by CSU Police that it is safe to leave.
Proceed immediately to your designated area.
Stay away from electrical power sources, fallen lines, buildings or other tall objects.
DO NOT smoke. Gas lines may have been ruptured.
FLOODING/WATER DAMAGE
INTERIOR FLOODING
1.
Evacuate the affected area.
189
2.
3.
4.
5.
6.
Report to designated area.
Call Facilities for assistance in having water shut off.
#10077
Call CSU Police at 911 from a near by building and have the following information available;
a.
State your name.
b.
State the purpose of the phone call (police, fire, ambulance needed).
c.
State the location of the emergency, include building address, room # or area.
EXAMPLE: Veterinary Teaching Hospital, Clinical Pathology Lab, Room C104.
d.
State what type of emergency has occurred (fire, chemical spill, flooding, etc.).
e.
Indicate if people are injured or trapped.
f.
Provide information on special precautions that response personnel should take. See “Special
Areas” page.
g.
Let the police end the phone call, thus assuring they have all the information they need.
Stay away from all power sources.
Stay away from utility vaults.
EXTERIOR FLOODING
1.
2.
3.
4.
5.
6.
Remain calm.
Call CSU Police at 911 and have the following information available.;
a.
State your name.
b.
State the purpose of the phone call (police, fire, ambulance needed).
c.
State the location of the emergency, include building address, room # or area.
EXAMPLE: Veterinary Teaching Hospital, Clinical Pathology Lab, Room C104.
d.
State what type of emergency has occurred (fire, chemical spill, flooding, etc.).
e.
Indicate if people are injured or trapped and how many people are with you.
f.
Provide information on special precautions that response personnel should take. See “Special
Areas” page.
g.
Let the police end the phone call, thus assuring they have all the information they need.
If at all possible have a phone, radio, flashlights and first aid kits available.
If there is water all around the building, proceed to the roof of the building or the highest point
accessible.
If there is water on only one side of the building, proceed in an orderly fashion out of the building exit that has
NO water.
Immediately go to the highest area possible.
MEDICAL
1.
2.
3.
4.
5.
Remain calm.
Survey the scene for additional dangers (i.e. electrical cords still plugged in, hazardous materials leak, etc.)
Call CSU Police at 911 and stay on the line until dispatch tells you to hang up.
DO NOT move the victim or give first aid unless you are trained and certified to do so.
Remain with the victim and try to keep the victim warm and alert by talking with them until emergency response
teams arrive.
TORNADOES AND WINDS
1.
2.
Proceed to the nearest interior room that has been designated as a tornado evacuation point and close the
door. If at all possible have a phone, radio, flashlight and first aid kit available.
Contact CSU Police at 911.
190
3.
4.
Monitor the storm by listening to the radio. DO NOT LEAVE THE TORNADO EVACUATION POINT SAFE
AREA UNTIL TOLD TO DO SO. CSU Police and Poudre Fire Authority will be making rounds throughout
campus determining damages and will contact you when it is safe to leave the building. This may take awhile,
so remain in the designated area until you are contacted to leave. There may be structure damage.
NOTE: Tornadoes have been known to leave the ground and come back down again in a matter of minutes or
even as long as half an hour. Remain in the designated area until notified by CSU Police or Poudre Fire
Authority that it is safe to leave.
OTHER EMERGENCIES
ASSAULT, HARASSMENT, DESTRUCTION OF PROPERTY, MUTILATION, VANDALISM, PROBLEM PATRONS
AND THEFT
1.
2.
3.
4.
5.
Call CSU Police immediately at 911
Notify the building proctor at 70340, 71269.
Observe suspicious persons but DO NOT TRY TO DETAIN THEM.
Ask the victim to remain until CSU Police arrive.
Obtain names, addresses and telephone numbers of witnesses.
POWER FAILURE
1.
2.
Facilities maintenance will be contacted by departmental personnel #10077.
CSU Police will be contacted by departmental personnel after normal working hours and on the
3.
Notify the building proctor Jim Flowers
568-9605 HOME
217-9407 CELL
or assistant proctor Kathie Sexton
484-7362 HOME
420-7015 CELL
Animal care/custodial staff should check room B113C, ACC139, ACC239 (these rooms house a number of subzero freezers that need to be set). They should start with the first name on the list and continue calling until
someone is contacted.
4.
weekends.
BOMB THREAT
1.
Locate the FBI Bomb Data Questionnaire and fill it out while talking to the caller. If the questionnaire is not
immediately available, record every word spoken by the caller and any background noises. Then immediately
fill out the Bomb Threat Questionnaire.
2.
Alert a co-worker via a note (if possible) while on the line with the bomb threat. Have the co-worker call CSU
Police at 911 and have the following information available; where the bomb threat is, who is taking the bomb
threat call, an estimate of how many people are in the building. Stay on the line until the dispatcher tells them to
hang up.
3.
Notify the building proctor Jim Flowers
or assistant proctor Kathie Sexton
4.
Evacuate the building immediately.
70340
71269
568-9605 HOME
484-7362 HOME
217-9407 CELL
420-7015 CELL
SNOW EMERGENCY
Administration will inform the Director‟s office of any closures during normal business hours. The Director‟s office will
get the word of closures out to all areas.
Call 491-SNOW (491-7669) to get the latest information about University operations during severe weather. Students
191
and university employees are encouraged to call the Snowline to keep emergency lines open.
Emergency preparedness procedures at Colorado State University are continuously monitored, tested, and adjusted as
needed. One of the most critical elements of the CSU emergency plan is communication, and various communications
vehicles are employed to get information out as soon as possible. Below are the most common ways in which
emergency information can be accessed:
Emergency Information Phone Lines

Snowline - A recorded message about University operations during severe weather is available at 491-SNOW
(491-7669). Students and university employees are encouraged to call the Snowline to keep emergency lines
open.
Fort Collins & Denver Media Outlets



The following radio stations broadcast emergency/closure information: 530-AM, KOA-AM (850), KCSU-FM
(90.5), KUNC-FM (91.5), KTCL-FM (93.3), KGLL-FM (96.1) or KPAW-FM (107.9)
• The following television stations broadcast emergency/closure information: News 7 on KMGH-ABC, Fox 31
News on KDVR-FOX, 9 News on KUSA-NBC, and News 4 on KCNC-CBS.
The following newspapers run emergency/closure information online: Coloradoan, Denver Post, and Rocky
Mountain News.
CSU Website

The Colorado State University homepage (www.colostate.edu) links directly to this emergency information web
page and will be updated with emergency information as needed.
E-mail

Administration will communicate emergency information and campus status updates via university e-mail. Thus
it is critical that students and faculty access the e-mail associated with their e-ID regularly.
SAFETY IN OFFICES OR CLASSROOMS DURING A CRISIS
Be aware of ‘threats’ in the environment from home, to CSU, and back home again
It is more likely you‟ll be in a vehicle accident than a „shooter‟ or terrorist situation – be prepared and aware of
all of the possibilities. Watch how people behave and what they are carrying in hand or backpacks, etc.
If it „feels suspicious‟, it very likely is – call and let authorities check it out. “Better safe than sorry” can really
apply in these situations!
What are Your Advantages?
o Preparedness – you‟ve thought about the possibilities and have a personal plan!
o
Observation – you „keep alert but relaxed‟ and know what dangers, suspicious persons, objects, or
weapons are near you
o
Awareness of Your Environment – you know your workplace and how to control access, lighting, power,
etc. better than suspects probably do.
192
o
Awareness of Your Resources – you know what actual or „impromptu‟ weapons are within your reach
(for example – pencils, a chair, flashlights, etc.)
o
Readiness to Respond – because you have PRACTICED for several possibilities – YOU ARE READY
TO RESPOND TO THE THREAT CONFIDENTLY!
What Are the Options?
In a crisis, your options are limited so practice beforehand is CRITICAL!
o
DEFUSE? Recent violent incidents indicate that the „suspect‟ has no intention of survival after the
violence so the probability of success in negotiations is very limited.
o
ESCAPE? Can you and your staff/students safely get away from the person, threat or situation without
encountering further danger? A very good option if possible.
o
EVASION – Can you and students/staff hide or be concealed behind substantial cover or out of sight?
Remember, dry wall and light building materials or wooden doors will not stop bullets. Another good
option if possible.
o
ATTACK – Can you and staff/students overcome or eliminate the suspect or threat with minimal
„collateral damage‟ and fewest injuries or casualties? Not a favorite thought, but a very possible reality.
o
How Should I Respond to the Threat
1) If the shooter is outside your building:
a) Turn off all the lights, close and lock all windows and doors. If you cannot lock the door, try to block the
door with desks and chairs.
b) If you can do so safely, get all occupants on the floor and out of the line of fire.
c) If you can do so safely, move to the core area of the building and remain there until the police tell you it is
safe to leave. Do not respond to commands until you are certain they are issued by a police officer.
2) If the shooter is inside your building:
a) If it is possible to escape the area safely and avoid danger, do so by the nearest exit or window. Leave in
the room books, backpacks, purses, etc.
b) As you exit the building, keep your hands above your head and listen for instructions that may be given by
police officers. If an officer points a firearm at you, make no movement that may cause the officer to
mistake your actions for a threat. Try to stay calm.
c) If you get out of the building and do not see a police officer, attempt to call the police by dialing 911. Tell
the dispatcher your name and location and follow their instructions.
d) If you are unable to escape the building, move out of the hallway and into an office or classroom and try to
lock the door. If the door will not lock, try barricading the door with desks and chairs. Lie on the floor and/or
under a desk and remain silent. Wait for the police to come and find you.
3) If the shooter enters your office or classroom:
a) There is no set procedure in this situation. If possible, call 911 and talk with a police dispatcher. If you
cannot speak, leave the phone line open so the police can hear what is going on.
b) Use common sense. If you are hiding and flight is impossible, attempts to negotiate with the suspect may
be successful. Playing dead may also be a consideration.
c) Attempting to overcome the suspect with force is a last resort that should only be considered in the most
extreme circumstances. Only you can decide if this is something you should do. Remember there
may be more than one shooter.
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d) If the shooter exits your area and you are able to escape, leave the area immediately. Do not touch
anything in the area and remember to be alert for responding police officers who may mistake you as the
shooter.
e) While escaping, as soon as you see a police officer put your hands over your head and immediately
comply with the officers instructions.
4)
What else can you do? Prepare a plan of action for an active shooter in advance. Determine possible escape
routes and know where the nearest building exits are.
How Will Police Respond to Active Shooter Response?
1.
The CSU Police Department (CSUPD) is a full service professional law enforcement agency that is trained
and equipped to respond to an emergency incident of this nature. During the initial phase of the incident, the
CSUPD and, if necessary, other law enforcement agencies, will evaluate the situation to determine the best
course of action for the safety of the CSU community.
2.
As officers move into the affected area, rescue efforts will be delayed until the shooter is located and
stopped or no longer a threat to life safety.
3.
If you are wounded or with someone who is wounded, these officers will bypass you to search for the
shooter and stop the threat. Rescue teams will follow shortly to aid you and others.
4.
To assist the police, please stay calm and patient during this time, and do not interfere with police
operations. If you know where the shooter is, and/or have the shooter's description, inform the police.
5.
When you encounter the police, keep your hands empty and in plain view at all times. Listen to their
instructions and do exactly what they say. If you are evacuating, carry nothing that could be mistaken for a
weapon.
6.
Rescue teams will follow shortly after the first responding officers enter the building. They will attend to the
injured and remove everyone safely from the area.
How will Fire and Ambulance Respond?
1.
Poudre Fire and Emergency Medical Services staff and vehicles will respond to a „staging area‟ (location to
prepare resources) that is far enough away for safety and close enough for immediate response as directed by
the Incident Commander.
2.
The Incident Command Process will be used to guide each resource needed to the right location in a prompt
and safe manner.
Media, Parent and Student Responses to Expect
1.
Expect the cell phone system to be used extensively by students, parents, media, and others! Don‟t depend on
cell phones for communication and expect media and parents to arrive in the area quickly.
2.
With supervisors, Directors, and Department Heads, pre-determine how you will handle parent questions,
media inquiries, etc. during and after an emergency. We suggest you make use of Media Relations and work
with them PRIOR TO the emergency!
3.
Work with the Counseling Center and Employee Assistance prior to emergencies to determine resources
available, how to respond to staff and student needs, and even be prepared to assist groups of students and
parents in dealing with the emergency!
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SOFT TARGET AWARENESS AT COLORADO STATE UNIVERSITY
WHAT IF someone put a combination of simple cleaning supplies in the ventilation ducts of your facility? Do you know
what damages or injuries could be caused? Do you have an evacuation and response plan? How long would it be
before your operation was „back to normal‟ and how would your staff get there?
United States law defines terrorism. “The term „terrorism‟ means premeditated, politically motivated violence
perpetrated against noncombatant targets by sub national groups or clandestine agents, usually intended to influence
an audience.”
Key Factors in Terrorism include: Fear, Coercion, Intimidation, Influence of political behavior, and being
observed/known by/to the public. Basically, it is an act of „bullying‟. Women and children are being used more and
more often to perpetrate terrorist acts! The best manner of deterrence and prevention is good planning and good
surveillance.
The Importance of Surveillance:
Culture – are we aware of who is watching our buildings and activities? Terrorists will go to other, less
prepared, facilities. Are we lax in such observations? Terrorists seek targets such as these!
Assets – the very programs/concepts/operations that make our facilities useful for teaching, research, and
service are the things that make them attractive targets. What ARE the assets of your building or facility?
Vulnerabilities – do we have areas that are accessible to the public and DO WE notice: prolonged behaviors,
patterns of behavior, and locations of behavior that police should be made aware of?! (e.g. Is a transient
sleeping or observing your operations and security? Could someone throw something in a dumpster or near
your building that could harm your operations? Would your staff challenge the person or call police???)
Escape – other than suicidal actors, all terrorists (e.g. Terry McVey) want to get away safely and unnoticed if
possible! BEAR IN MIND THAT DURING THE LAST TWO YEARS – THE SUSPECTS HAVE HAD NO
DESIRE TO ESCAPE OR SURVIVE THEIR INCIDENTS! Pre-plan YOUR course of escape or location of
safety during a violent event!!
Awareness Training
- Make sure your staff recognizes behaviors under Vulnerabilities above!
- Have a plan and practice it to make sure authorities and your staff get notified on a timely basis
- Know WHO TO CALL (list numbers), WHAT TO REPORT, and WHAT YOUR STAFF SHOULD NOT DO
(for example – NEVER touch a suspicious/unattended package/object/suitcase/etc.!)
- Have you reviewed all emergency management plans and updated them?
Sometimes simply knowing that their actions have been observed by attentive personnel/staff will move an attacker to a
different location – NOT YOURS! Though NO threats against the Ft. Collins community or CSU are considered
authentic at this point, current information indicates that the most likely form of any attack would be an improvised
explosive device.
The best deterrent is to observe any person investigating your facility for how, what, when, and where to place a device
for the most devastating impact!
This training doesn‟t replace the need for your staff to have CPR/AED, evacuation procedure, workplace violence
recognition training, but supplements it with knowledge of what to do IF an activist/extremist/terrorist should show up at
your door. Remember – Deter, Detect, Defend! These actions in planning, prevention, and response will „devalue‟ your
facility as a suspect‟s potential target! We need to think that „IT CAN/MAY HAPPEN HERE‟.
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Colorado State University Veterinary Teaching Hospital
DISCOUNT POLICY
The Veterinary Teaching Hospital provides a 40% discount on all services to PVM
students, residents, graduate students and interns. Exceptions to this are drugs and
supplies from Pharmacy and Central Supply, which are discounted 0-25%. There are no
discounts from the Diagnostic Lab or on any service or item that is a hard cost to the
Veterinary Teaching Hospital. There is no discount on the Outpatient Day Fee, and this
fee must be paid the day(s) the animal is at the hospital.
Residents, graduate students and interns that are not funded by the department of Clinical
Sciences (this does not include PVM students), must provide written verification from
their Department Head stating:
Name
CSU ID number
Funding Department Name and Number
Status (resident, graduate student, etc.)
Verification must be on department letterhead and be signed by the Department
Head. You can scan the letter and send it by email if this works for you.
If a resident, graduate student or intern does not present the letter of verification to the
Business Office PRIOR to admission, a discount cannot be allowed.
It is the responsibility of the resident, graduate student, intern or PVM student to notify
the admissions desk PRIOR to admitting an animal for an appointment. An invoice
opened at the front desk for any reason will require an exam fee. If submitting a lab
sample(s) or obtaining a Pharmacy item only, a "Client Only or C-invoice" may be
opened by the Clinical Pathology Lab or Pharmacy, and the exam fee will be waived.
However, lab results will not become part of an animal's permanent record.
An entitled discount will be automatically computed at dismissal. The invoice balance is
due when the animal goes home or the day samples are submitted. Invoice balances
cannot be charged to a student account. 'T'hc pet receiving the rnedical care must be
owned by the person entitled to the disco~mtA. ny "sharing" ofthe discount is a honor
board violiltion. this is a serious infraction and ~villb e dealt with as such.
If an outstanding bill is not paid within 30 days, a resident, graduate student, intern or
PVM student will lose the discount, a handling fee will be added, and the balance will be
transferred to Commercial Accounts Receivable on main campus. An outstanding
balance at Commercial Accounts will be handled by the University as any other student
debt.
If there are any questions regarding the policy or procedures, please stop by the Business
Office.
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CareCredit Information
Thank you for your interest in CareCredit. The CSU Veterinary Medical
Center is pleased to be able to offer you this payment option. Please read
this carefully and if you have any questions, please ask for a Business
Office representative to assist you during normal business hours (8am5pm Monday-Friday, excluding holidays). If you have questions about
CareCredit outside of normal business hours, please see a receptionist.
CSU Veterinary Medical Center is offering the following promotional
programs through CareCredit:
Interest Free Plan:
Treatment amount of $300.00 or more .... 3 months NO INTEREST*
 No interest will be charged if at least the minimum monthly
payment is paid
on time
 Promotional balance must be paid within 3 months to have no interest fees
assessed
 If balance is NOT paid within 3 months, a 22.98% variable interest rate will
apply.
Extended Payment Plan : Treatment amount of $1000.00 or more
Competitive interest rate of 11.9% APR for:
 24 months
 36 months
 48 months
 60 months

We do accept CareCredit for any amount you are approved for, even for
less than $300.00, but it will not be part of any promotional (interest free or
low interest rate) plan and will be considered "revolving". The variable
APR for "revolving" transactions is 22.98%.
For online applications (clients), please go to www.carecredit.com or call
(800) 365-8295.
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HAY SHED CLEANING PROCEDURE
Each week the individual bays and surrounding areas in the Hay Shed are cleaned of all debris and any
animal waste that may be present. Debris and any animal waste is picked up and/or raked up and
disposed of to a proper location. When complete, the individual cleaning the area must initial the
Weekly Clean-up Check Sheet posted in the hay shed.
PASTURES/DRY LOTS CLEANING AND FEEDING
PROTOCOL
Feeding the Pasture Animals
Every morning, seven days a week, at approximately 7 am the animals are fed according to their specific
dietary needs and amount of animals present at that time. Each pasture has enough feeder and bunk
space for all animals present. Feed which falls on the ground is cleaned once a week, weather
permitting.
Cleaning of the Pastures/Dry Lots
The pastures/dry lots are cleaned once a week weather permitting. They are scraped/cleaned with a
box scraper attached to a tractor. All sheds and shelters within the pasture/dry lot are cleaned of
manure once a week also. The animal manure and excess feed on the ground is scraped in to one pile
and hauled out to an appropriate location. If there has been excessive moisture accumulation in the
feeders, they will be emptied of all damaged remaining feed.
The waterers in each pasture/dry lot are cleaned with a scrub brush once a week. All debris and algae
is removed/scrubbed from the troughs.
Revised 10/12/11
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December 28, 2006
TO:
Faculty, House Officers, Staff
and Students
FROM:
Dr. Dean Hendrickson
Hospital Director
SUBJECT:
Outpatient Day Fee
This memorandum is intended to reiterate the VTH Board policy regarding an „Outpatient Day Fee‟ to help recover costs associated
with maintenance of hospital biosecurity protocols. This fee applies to animals housed in a cage or run for a one day (not overnight)
stay at the hospital. The fee is $6.50 and applies to all animals: client, faculty, house officers, staff and students.
If an animal does not have an appointment, VTH affiliated personnel (faculty, house officers, staff and students) should not bring
their animals to the hospital without approval from the VTH Director. Only extreme circumstances are considered and whenever
possible, people are encouraged to board or house their pets in one of the many facilities in town. If approved for the VTH, a card
is issued from the Director‟s Office and the fee is paid immediately at the Business Office. The Business Office will mark the card
as paid. The student discount does NOT apply to the „Outpatient Day Fee‟. Blood donors are excluded, as are animals used for
teaching. Exclusion for an animal that is to be part of classroom teaching requires a clinician signature on a cage card which is
again issued from the Director‟s Office, or possibly handed-out from the service technician. Animals with an appointment will see
the „Outpatient Day Fee‟ on their invoice and will have a regular cage card identifying their animal.
Owners must still clean up after their animals when approved to spend all/or a part of the day at the hospital.
dayfeetoall_memo28dec06rev
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Policy Title: Sharps Handling Policy and Procedure
Effective Date: August 2010
Office of Origin: CSU VTH Director’s Office
Policy Approval: CSU VTH Director’s Office and VTH Board
Distribution: VTH Hospital Policy and Procedure Manual
Introduction:
Colorado State University Veterinary Teaching Hospital is dedicated to supporting a safe environment while fulfilling
our mission which is to educate the next generation of veterinarians by providing exceptional veterinary care and
service to the community…every day. The purpose of this policy is to ensure a safe method for using and disposing
needles and sharps at the VTH. The VTH will enforce this policy and supporting procedures to ensure a safe working
environment.
Policy:
VTH personnel are entrusted to deliver care and teaching in veterinary medicine with the upmost regard for the safety
of self and others. Personnel should minimize the risk of injury by handling sharps in a safe and appropriate manner.
This policy is applicable to all VTH personnel handling sharps and applies at all times. All VTH personnel are
responsible for knowing and following the VTH Sharps Handling Policy and Procedures. Staff and Faculty are
responsible for ensuring that all new personnel, including students, are appropriately trained in handling and disposal
of sharps at the VTH.
Definitions:
“sharps”- Sharps are any item that can cut or puncture skin. These include but are not limited to the following items:
hypodermic needles, blood collection needles, catheters stylettes , scalpel blades, razors, suture needles, and broken
glass.
“hazards”-A chance of being injured or harmed. The primary hazard related to sharps injuries in animal health care
workers at the VTH is physical injury, and associated complications such as infection of wounds. Lesser hazards include
exposure to harmful or toxic substances.
“VTH personnel”-students, staff and faculty
“blood borne pathogen exposure”- Blood-borne pathogen exposure is a potential, but uncommon hazard to personnel
at the VTH because of the types of patients that are commonly seen. Non-human primate patients are an exception,
and accordingly there are special policies that must be followed regarding their care (see non-human primate section
of Biosecurity SOP).
Procedures:
1. Routine Handling of Sharps:
a. Personnel should use disposable trays/carts to carry unused and used sharps when possible.
b. Personnel performing treatments in stalls or cages should always place materials required for treatments,
including sharps, on disposable trays before entering. Place trays on stable, flat surfaces to avoid spilling
contents into bedding.
c. ALL sharps should be accounted for before and after procedures have been performed.
d. Immediately place used sharps in appropriate containers for disposal.
e. The VTH will provide suitable containers for disposal of sharps throughout the facility. Do not overfill a
sharps bin. Replace sharps bin containers when they have filled to the appropriate level.
2. Sharps Disposal:
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a. Personnel must dispose of sharps immediately after use in a container designed for this purpose. The
person using the sharp is responsible for appropriate disposal.
b. Extreme care should be used when removing needles from syringes and blood collection devices. Forceps
should be used to handle used needles and blades when appropriate to reduce the risk of injury.
c. Care should be used when removing hypodermic needles and dispose of used syringes in appropriate
containers. Do not re-cap needles if work is being performed adjacent to an appropriate sharps container.
Dispose of needles directly into the sharps containers if close in proximity.
d. Special considerations:
i. Glass: Broken glass should be disposed of in sharps containers when possible. Material that will not
fit in sharps containers should be carefully sealed in an appropriate puncture resistant container,
labeled “Broken Glass”, and taken to central supply to be disposed of appropriately.
ii. Large sharps: Sharps should be placed entirely within appropriate containers when disposing of
them. Sharps too large for normal containers should be packed in puncture resistant material, labeled
“Sharps”, and taken to central supply for appropriate disposal.
iii. Glass thermometers: Personnel should not use thermometers containing mercury. If use of glass
bulb thermometers is necessary, personnel must ensure that they contain substances other than
mercury.
e. Clients may purchase sharps containers from our Pharmacy for disposing household-generated sharps. The
Colorado Department of Public Health and Environment, Hazardous Materials and Waste Management
Division offers guidance in their bulletins entitled "Household Medical Waste Management" and Infectious
Waste Management. The VTH cannot dispose of client household-generated sharps or any sharps of unknown
origin or that originate outside of the VTH.
3. Lost Sharps:
a. It is important to note that accidental loss of a needle or sharp is not a punishable action unless this action
is repetitive or involves gross negligence. It is, however, a serious and punishable infraction if this loss is not
reported or handled appropriately.
b. Personnel responsible for a missing needle or sharp should thoroughly examine the surrounding area to
locate the item.
c. If the responsible party cannot find the sharp, they should immediately notify the supervising technician for
that service area. Personnel will also need to report lost sharps on the following web page:
http://southcampus.colostate.edu/minutes/scehsc/sharps/
d. The responsible technician will confirm that a thorough search has been conducted.
e. If the item still cannot be located then the responsible technician will ensure that adequate and effective
communication with the cleaning crews has occurred notifying them of the lost needle or sharp. Cleaning
crews will also be alerted verbally to the hazard when possible. Prominent notices will also be immediately
placed on the stall, cage, room, or drain where the sharp was lost. Cleaning crews should notify the
responsible technician if the sharp is found
4. Found Sharps:
a. Sharps that are found in the hospital should be immediately placed in an appropriate container for disposal.
They should not be collected or taped to records, stall cards, or other surfaces.
b. When it is discovered that sharps have been inappropriately disposed, these incidents must be reported to
the supervising technician for that service area AND
i. Additionally, personnel should report found sharps using the following web page:
http://southcampus.colostate.edu/minutes/scehsc/sharps. This must not take the place of
reporting found sharps to supervising technical staff as noted above.
ii. Supervising technicians will attempt to identify the person responsible for the sharp.
iii. Supervision technicians will also keep the section head appraised of these occurrences.
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iv. Section personnel will be alerted to the inappropriate disposal of sharps to encourage appropriate
management of sharps.
c. These policies also apply to sharps found by personnel in laundry or central supply.
d. Supervising personnel will make appropriate efforts to identify personnel responsible for the lost sharp,
discouraging repeated occurrences and re-educating personnel.
e. Because it is not acceptable to bring in sharps from outside the VTH, sharps found in the hospital that have
been brought in from clients or dropped off by an unknown source must be treated as a biohazard waste.
Gloves must be worn to bag the item in a biohazard container or bag. Also, please have the supervising
personnel or Director’s Office contact Environmental Health Services for pick up.
5. Personnel Responsible for Cleaning:
a. Personnel responsible for cleaning should always be cognizant that drains, trash, bedding, and other
material could potentially contain sharps that have been lost or disposed of inappropriately.
b. Personnel should never place a hand in any drain or container without first visually inspecting it for sharps
hazards. A flashlight or other light source should be used when necessary.
c. At the start of shifts, personnel responsible for cleaning should check areas for notices of regarding lost
sharps.
d. Personnel should make special effort to locate the lost sharp when cleaning that location. If the sharp is
found, it should be disposed of properly and the supervising technician for that area should be notified that
this sharp has been located.
6. Sharps Injuries:
a. If personnel sustain a sharps injury, the wound should be cleaned immediately with soap and water.
Personnel are encouraged to seek designated medical attention for these injuries if appropriate. Staff and
faculty are required to fill out the online EHS injury report form if an injury has occurred at
http://www.ehs.colostate.edu/WWorkComp/OnlineInjury.aspx.
b. Personnel sustaining sharps injuries are required to fill out the online report located on the south campus
website at http://southcampus.colostate.edu/minutes/scehsc/sharps.
Failure to Follow Policy: All VTH personnel are responsible for appropriate handling and disposal of needles and
sharps.
i. Personnel that are found to be negligent in handling and disposal of sharps may subject to disciplinary
action.
ii. Gross and repeated violations of policies regarding sharps are grounds for dismissal.
iii. Noncompliance that is reported to regulatory agencies can result in imprisonment and fines (up to $25,000
per day for the individual and the institution) if personnel are found to be negligent.
Approved:___________________________________________________________ Date:_________________
Signature of Review and Understanding:
Employee Name (please print):
Employee Signature:
Date:
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Colorado
State
University
TRANSFER OF OWNERSHIP/REFERRING VETERINARIAN
Veterinary Teaching Hospital
Attn: Medical Records
Colorado State University
Fort Collins, CO 80523
Case Number______________
I. TRANSFER OF OWNERSHIP
I,
state that I no longer own or am associated with
(animal name) and hereby authorize CSU
Veterinary Teaching Hospital to release all medical records to present
Owner _____________________________________ .
_______________________________________________________________
Signature
Date
THIS SIGNED RELEASE MUST BE RECEIVED BY MEDICAL RECORDS
BEFORE A COPY (OR ANY PART) CAN BE RELEASED
II. CHANGE OF REFERRING VETERINARIAN
I,___________________________ hereby authorize CSU Veterinary Hospital to
release medical records for ________________________ (animal name) to:
___________________________________________
___________________________________________
___________________________________________
___________________________________________
for the purpose of __________________________________________________
________________________________________________________________
Signature
Date
THIS SIGNED RELEASE MUST BE RECEIVED BY MEDICAL RECORDS
BEFORE A COPY (OR ANY PART) CAN BE RELEASED
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College of Veterinary Medicine
and Biomedical Sciences
Associate Dean for the
Professional Veterinary Medical Program
Office:
(970) 491-7592
Cellular: (970) 222-1902
Martin.Fettman@ColoState.EDU
Office of the Dean
Fort Collins, Colorado 80523-1601
Office:
(970) 491-7051
Facsimile:
(970) 491-2250
www.cvmbs.colostate.edu
21 April 2003
MEMORANDUM
To:
VTH Faculty, Staff, and Students
From:
Dr. Marty Fettman, Interim Director
Re:
VTH Referral Policy
VTH policy regarding referral of our clients to other veterinary practices
or allied pet care facilities.
As a public institution, the VTH cannot provide preferential recommendations to clients for referral to outside practices for
veterinary medical care, or to businesses that provide grooming, boarding, hospice care, cremation or other allied pet care services.
However, it is our duty to provide unbiased information when requested.
If an individual who requires general medical or surgical attention for their animal requests referral information for general
veterinary practitioners, please refer them to the local telephone directory yellow pages. If the VTH cannot accommodate an
individual quickly enough, who requires specialty practice attention for their animal, the names and contact information for
local/regional specialty practitioners may be provided. A list of these specialty practices is maintained and updated regularly by the
VTH Front Reception Desk, based upon those practitioners who have indicated willingness to be referred to when needed.
If a client requests referral information for ancillary pet care services, including but not limited to grooming, boarding, hospice care,
or cremation, the names and contact information for local/regional businesses may be provided. VTH personnel are urged to
remember that such outside businesses may not be subject to accreditation or inspection standards like those used to certify
specialty practitioners or veterinary practices. As such, VTH personnel cannot certify the quality of care provided by these services
at any one time, though past personal experience with individual businesses may be provided if the client request such information.
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