Critical Thinking Skills
Megan Brashear, BS, CVT, VTS (ECC)
DoveLewis Emergency Animal Hospital Portland, OR
Critical thinking involves putting together all of your knowledge sources to lead you to a decision. It involves
your book and school knowledge, asking intelligent questions of those you work with, and thinking through your
past experiences. One who thinks critically can adapt to new situations, and puzzles out answers even when
faced with unfamiliar information. In medicine, critical thinking is a vital skill that technicians should be
practicing and perfecting every day.
I am not a fan of cookbook medicine. ‘Because I was told’ is never a good enough reason to perform a treatment
on an animal. Yes, as a technician it is your job to carry out the DVMs orders. But perform that treatment
because you understand the motivation. What is happening in that patient that requires this medication? Why is
it happening to that patient? How does this treatment or medication help this pet’s situation? And why was this
treatment chosen now? Knowing the answers to these questions will help you become a better technician and
enrich your experiences with your patients.
Test yourself at work by anticipating results. Look at the presenting complaint, medical history and physical
exam results on a sick patient and anticipate their blood values. Anticipate what you may find on radiographs.
Were you right? If not, why? Did you learn something new? I try to anticipate the results of vital signs every time
I perform treatments on a hospitalized patient. If that dog is sleeping soundly and breathing comfortably I
anticipate a heart rate of maybe 70bpm and a normal blood pressure. If his heart rate is 190bpm and his blood
pressure is elevated, something is wrong. Maybe I used a different blood pressure cuff or a different machine
than the last time. Maybe I take the dog out to urinate and recheck his vitals. If they are still elevated I will
report those to the doctor, but at least I have thought through some problems and I am confident in my results.
If I simply wrote those numbers down and moved to the next patient, I am not utilizing my skills and knowledge
to their potential.
As a technician, you may not have the authority to change orders, add medications, or make a diagnosis, but
that doesn’t mean that you can’t educate yourself in all of those areas. When medical orders are made, ask
yourself why? Why are we using this antibiotic over that one? Why is this patient having an arrhythmia now?
Why is the blood pressure dropping in this situation and can I do anything about it? Why are we giving a fluid
bolus now? As you learn more you will be better about anticipating these changes in the next patient that you
treat and you will be prepared. When the doctor orders that fluid bolus you will be ready. You will know that the
blood pressure is dropping and be ready with the treatment.
It is important to remember that even though you may have all kinds of fancy monitors and tools to tell you how
a patient is doing, it is still important to use your skills of observation. You, the technician, can anticipate what’s
coming next. A monitor can only tell you what is happening right now. As you progress in your career, remember
what has happened in the past. Collect anesthesia records and case reports of interesting diseases and
experiences to help you remember them. Rely on your observations. Are the gums less pink than they were an
hour ago? Do those pulses feel more thready than when the dog came in? Is that breathing pattern different?
These are clues that no monitoring equipment will be able to detect. A skilled technician can never be replaced
if they are using their critical thinking skills. Finally, rely on your gut feeling about a patient. If something just
isn’t right, stick with that and continue to monitor closely.
Let’s take a case and work through it, using critical thinking skills to come to some decisions. You are running
anesthesia on a young dog with a GI foreign body. He has been vomiting for a couple days and is dehydrated but
otherwise has a normal physical exam. He gets IV fluids pre-op for a few hours and his anesthesia induction goes
well. As you get into surgery, the dog’s heart rate climbs and he is tachycardic. What is your next step?
First, go through the potential reasons for tachycardia: pain, hypovolemia, anemia, hypoxia, and surgical
manipulation. You can rule out anemia, as the PCV was normal heading in and there is no evidence of blood loss
intraop. The dog is intubated with normal Sp02 and respiratory values, his mm color is pink and his ETC02 is
normal so you can rule out hypoxia. You are left with pain, hypovolemia, and surgical manipulation.
Next, look at your other monitoring parameters. How is the blood pressure? What is the surgeon doing at the
moment? What is the CRT? Do the intestines look dry and tacky? Using this information you can decide to
increase the inhaled gas, give a fluid bolus, or administer pain medication to correct the tachycardia.
A technician not used to using critical thinking skills would probably reach for the gas inhalant and turn it up. But
what if the blood pressure was borderline low? Increasing gas inhalant will drop that blood pressure lower. By
thinking through the entire situation, using what you know and what your monitors are telling you, you can
make the best decision for the patient.
Now let’s try a cat, 16yrs old that comes in for vomiting and lethargy. On physical exam the temperature is
decreased, heart rate is increased, and systolic blood pressure is barely normal. Already my hackles are up about
that. An elevated heart rate and barely normal blood pressure mean this cat is working really hard to be
‘normal’ and with the decreased temperature is about to head off the cliff into REALLY sick. What next? What do
you think is wrong? Lab work reveals azotemia (big surprise) and a PCV/TS of 25% and 11.5g/dl. How do you feel
about that? PCV maybe is a bit low but 25%, that’s okay. Right? If you only look at the PCV and not the total
solids you may be fooled into thinking the cat is okay. But looking at the total solids (of 11.5g/dl) and thinking
about the treatment for renal failure (days of IV fluid diuresis) you soon realize that once this cat is hydrated to a
normal total solids, the PCV will be diluted out and the cat may become clinical for anemia. Now you have that
in the back of your mind as you performing nursing care on this cat, and you are watching for the signs of
anemia. You may be checking blood work twice a day; you may be more alert to an elevated heart rate.
This cat will also have nutritional needs. Thinking about renal failure, how do you think this nutrition will be
delivered? Does the cat have oral ulcers? Should an NE tube be placed early and nutrition started? Will the cat
need an esophagostomy tube? Is syringe feeding a viable option? Sometimes using critical thinking skills can just
help you plan your day. If that cat is going to need some sort of feeding tube placed you can plan on the time
and be ready to go and not surprised when the order is given. “Anticipating needs” is an important skill for a
valuable technician and critical thinking will lead you to setting up before the doctor needs to ask.
Even if you have been a technician for years you can still challenge yourself and learn more. Pick a disease
process or type of cancer and learn all that you can about it. Choose a breed of dog and learn about their
inherited diseases. Study cytology and improve your cell identification skills. The more you learn the more you
will have to draw from when the need arises. Learn from those around you. Ask questions, participate in case
rounds, attend CE. Resist the temptation to do it just because you were told. Technicians are vital to a practice
because of our brain and our ability to think. Cultivate your critical thinking skills and you’ll be a valuable
resource in your practice.