What is Thrive 2021?
Thrive 2021 is a virtual conference that is designed to help after-hours emergency veterinary professionals (vets/nurses/reception teams) tackle the challenges they face in their demanding and highly stressful niche in veterinary medicine.  However, these same challenges are experienced by all members of the veterinary profession regardless of whether they are in after-hours emergency or not so there is value for all.
 
The goal of Thrive 2021 is to help participants develop healthy foundation habits, improved resilience and wellbeing, which will enable them to thrive and create a more sustainable career for themselves within the veterinary profession.  Thrive 2021 is an 3 day virtual conference where attendees go through a personal 4 step journey, a journey that will help them learn how to thrive in the after-hours veterinary environment, not just get by or survive.
 
www.thrivingvet.com.au
 
Thrive 2021 will provide masterclass level training, insights and coaching on topics such as:

– Confidence
– Aggressive clients
– Coping with grief
– Imposter syndrome
– Value and self worth
– Time management
– Team work
– Wellbeing and self care
– Stress
– Sleep
– Nutrition
– Energy

Veterinary professionals can have all the clinical skills and knowledge in world, however without mastering performance skills, they are unlikely to Thrive long term in an after-hours environment.  

When is Thrive 2021?
It is held online over three days in September, 1st, 2nd, 3rd.  
 
This immersive virtual conference perfectly blends together world class speaks who are at the top of their game, together with the latest in online education technology.

Go global from the comfort of your own home and experience:
* 3 days training and coaching
* 20 amazing expert speakers
* 14 day time sessions
*    6 night time campfire discussions
*    20 hours of incredible content
*    Access to the conference course post event
*    Digital showbag – containing free resources and discount offers

Cant attend live? You will get access to the conference as a course.
More information about the conference and the program outline is found on the website … www.thrivingvet.com.au

What are limiting beliefs? Can they be “unlearned” and challenged?
www.vetsuccessacademy.com

In this clip from the Vet Success Academy Performance April Live Training – we discuss how your social circle is vital for keeping your burnout risk score low.

Not a member and want to see more. Join now
https://www.vetsuccessacademy.com/performance

Spillage of stomach contents is one of the biggest concerns when performing a gastrotomy. There a couple of things that I do to reduce that risk and also to make performing a gastrotomy easier.

Maximising exposure of the stomach:

Extend your incision as cranially as possible, sometimes up around the xiphoid if needed (beware the diaphragm)
Remove the falciform fat, this one action can make a dramatic difference
Use Balfour retractors to keep the abdomen open


Remove as much fluid as possible:

Make sure the cuff is inflated properly as stomach contents can leak around the stomach tube into the pharynx
Pass the stomach tube and try to manipulate the stomach to see if any fluid can be removed
Later after you have made your incision use a suction tip to remove any additional fluid. Replace the suction tip later for lavage.

Control the stomach:
Place stay sutures at either end of the intended incision line to gain control of the stomach. Stay sutures can stretch out the stomach making it easier to incise. They enable you to lift up the incision line up and away from the stomach contents to reduce the risk of spillage. Finally, you can place additional stay sutures at the middle of your incision later for further visualisation.
When placing them take deep bites into the stomach wall and leave the ends reasonably long about 4 inches which can be clamped together with haemostats.

The incision is made in the avascular region of the stomach, in the middle of the greater and lesser curvatures. However, the location can be adjusted based on where you need to gain access. Ie. Closer to the pylorus for a foreign body that is located in the pyloric region.

Protect the abdomen:
Now that you know where to perform your incision, use the stay suture to elevate the stomach, and then pack off the abdomen with numerous moistened lap sponges.

Give these steps a go at your next gastrotomy!

To watch our full Linear Foreign Body Surgical Series, check out: https://www.vetsuccessacademy.com/clinical

This patient was brought to us for exercise intolerance, breathing difficulty and loud airway sounds.

www.minivetguide.com
www.vetsuccessacademy.com

SURGERY TIP 13: ADHESIONS … Natures own booby TRAP!

Adhesions .. are bands of fibrous scar tissue that form on organs in the abdomen. They can cause organs to stick to one another or to the wall of the abdomen.

They rarely form without some kind of prior inflammation or surgery.

Adhesions of the intestine can kink, twist, pull, or compress the intestines causing symptoms of abdominal discomfort and vomiting if severe enough. However in most patients, adhesions do not cause any clinical signs.

This patient required a caesarean section but had one performed previously. I was aware of this and was cautious entering the abdomen, as I have learned this the hard way before. Previously I almost transacted a piece of intestine adhered to the linea alba I was so close to spilling intestinal contents everywhere.

Adhesions… If need be can be broken down manually or with surgical instruments via a mix of blunt and surgical dissection.

This patient had several adhesions from a prior C-section, I slowly dissected them in order to gain access to the uterus.

If your patient has had abdominal surgery before… Keep adhesions in mind and enter the abdomen carefully, as it could save you a MAJOR head ache!

www.vetsuccessacademy.com/clinical

VSA CLINICAL IS NOW LIVE!! 🚀⁣

⁣https://www.vetsuccessacademy.com/clinical

Here we take you inside the emergency hospital and share the cases that we see on shift, showing you step-by-step how we work through a diagnostic pathway to a treatment plan for each patient.⁣
⁣
Imagine having access to a video library of real-life emergency cases at your fingertips. Our goal is to help the veterinary community feel more comfortable and confident in the management of emergency and critically ill patients. 😊⁣
⁣
Join us FRONT ROW at the crash bench. You will see from initial management, interventions and right through to the diagnosis. From DKA’s, Splenectomy’s, GDV’s, Foreign Bodies, Septic and Heart Failure Patients, & Toxicities. We will guide you through how we tackle these cases from start to finish. 🩺 ⁣
⁣
You will witness some of the most INTENSE moments in surgery and how we systematically worked through these tough cases.⁣
⁣
This is a monthly membership where each month we release a new:⁣
⁣
✅ Surgical videos⁣
✅ Medical case⁣
✅ Procedural video⁣
✅ Imagery video⁣
⁣
This months surgery is all about EMERGENCY SPLENECTOMY broken down into bite size videos totalling 2-hours, the medicine topic is XYLITOL, plus we show you our trusted approach to Placing a Central Line.⁣
⁣
There is also a surgery tip & procedure video library that will help you in general practice, with diagnostics, imagery and surgery, all ready for you to dive into as soon as you join. ⁣
⁣
We are offering early bird prices of $11.80 AUD per month, or sign up for the whole year at $89.80 AUD and save 37%. ⁣
⁣
@Dr Gerardo Poli

Removing the Falciform Ligament

While simple for some I didn’t do this for years!!! Why? Because I didn’t know how! I only needed to see it once for me to be comfortable doing myself. 🤯🤯 Ever since then it has made a significant difference in increasing my ability to visualise inside the abdomen. Especially the cranial abdominal structures. It is also super helpful in large and overweight patients.
So how do you do it!? 💥 The falciform ligament is attached to xiphoid as it extends caudally towards the umbilicus it is attached to the body wall on either side of linear alba. It is fed by blood vessels that arise from where it is attached near the xiphoid. 💥 After you have made your ventral midline incision from xiphoid to pubis. You cut through the thin reflections on either side of the linea alba with either electrosurgery or with scissors otherwise you can tear through it after clamping down and crushing the tissue with Carmalt clamps. When you get to the xiphoid area the fat is generally thicker and it contains the blood vessels. You can place a circumferential ligature around this and then when you tighten the ligature it can cut through the fat and ligate these vessels. Otherwise the fat can be crushed first with a Carmalt then a ligature placed. After ligature is placed you can transect the fat. If you use electrosurgery you can slowly cut and cauterize the fat and vessels, however, you must make sure you allow time for the vessels to cauterize.
After it has been removed make sure you look under to see if there is any bleeding.

If you found this useful, share it with your friends!

Cutting into the small intestine!!


Ok, this may be simple for some but some of you have not done it or even seen it. So here we go!


After isolating the segment with moist laparotomy sponges (see previous Surgery Tips) and pushing the ingesta away from that site and you can holding it back with either Doyon intestinal forceps or your assistant fingers (see previous Surgery Tip).


I usually make that incision in the aboral (or rectal) end of the object as this is usually the healthiest part of the intestine. I generally cut over normal intestine, but if the foreign body cannot be moved then at least half the of the incision through the normal intestine and half over the foreign body. An incision directly over the foreign body is not recommended because the intestine may be devitalised and therefore can impact the ability to heal which can lead to increased risks of breaking down later.


I use a scalpel to create a stab incision then I lengthen the incision with Metzenbaums, as I feel like I have more control over the incision compared to extending it with the scalpel. I also always put the instruments that enter the gastrointestinal tract (or a dirty area) into a tray to keep dirty instruments away from clean.

Want to know how to take the guesswork out of getting the temperature of your lavage fluid right? That is getting the temperature as close to body temperature as possible.

If YES then you have to thank the team at @perthvetemergency for this one. IT BLEW MY MIND when they showed me!

You can USE a LASER temperature reader to measure the temperature of your lavage fluid …. it is super quick, easy and sterile. You get them from the hardware store. Too hot?? … then add some cold, too cold … add some hot. I aim for 38.5 celcius or 101.3 fahrenheit.

Gauging the temperature of the lavage fluid by swirling your magic thermometer fingers in the bowl of lavage fluid or assessing it as it flows over your fingers into the abdomen can be subjective… Sure it might it be BUT it is still subjective.

Too hot you are inflicting pain and also giving the liver, kidneys, spleen, and gastrointestinal tract a light poach … Too cold… Then you drop the core body temperature, which leads to prolonged recovery and altered metabolism of drugs.

We are in COVID times…. All those laser forehead temperature readers you have NOW have another use after this pandemic!
Tip: You can also use it to measure how warm your hotties after too!

Your colleagues will want to know this one!. So share and tag as you see fit!

Enjoy team, G