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COURSE OBJECTIVES
1. This rotation will familiarize you with the techniques of examination and treatment of animals with ophthalmic disease.2. You should work to become proficient in the following areas:
SCHEDULE
Monday – Receiving new and recheck patientsTuesday – Surgery (rounds if time permits)Wednesday – Receiving new and recheck patientsThursday – Surgery (rounds if time permits)Friday – Morning receiving only, rechecks only
On Fridays the residents and faculty attend Grand Rounds at the Medical School at 7:30 AM. Student attendance is optional.
Emergencies and consults will be worked into the schedule.
Except for Large Animal cases, we do not get paged when patients arrive. Keep an eye on the schedule on the ophtho counter, and check the far left end of the rack on the reception desk for charts. When you take a patient, draw a single slash through the name on the schedule (it gets a complete “X” when the patient leaves.) Our exam rooms are 1079 and 1075, and we use the dentistry room (1163) as a back up when there are no dental procedures. If no room is available, greet the clients, do as much of the history, etc. as you can in the waiting area, and explain that we will get them in as soon as space is available. Large animal cases are seen in the procedures room (1230) or in the stocks closest to the entrance if 1230 is not available. Take one of the “Blue Bell” carts with you when seeing a case in LA.
New appointments last 60 minutes, so students have 30 minutes for their exams. New patients should get a complete, but brief, physical exam, including a weight, a general history if they have systemic problems, and an ophthalmic history on the separate form. New patients should all have Schirmer tear tests, fluorescein stain, and intraocular pressure measurements. EXCEPTION: cats with conjunctivitis should not have fluorescein stain at their first visits until after they have been seen by one of the doctors (fluorescein interferes with the IFA for herpes.)
Dr. Bentley and Dr. Murphy like to do a dilated fundic exam on all new patients. Please check the patient’s STT and pressures and dilate if appropriate BEFORE doing your history, physical, and the rest of your ophthalmic exam. Patients should be dilated with tropicamide only – check the bottle label, since the packaging of atropine is identical. EXCEPTIONS: glaucoma patients, patients with abnormal PLRs, and patients with iridial problems (e.g. iris melanosis) should not be dilated.
Recheck appointments last 30 minutes, so you have 15 minutes for your exam. DO AN OPHTHO EXAM ONLY (no physical) unless the animal’s systemic health has changed significantly since the last recheck. Small animal rechecks should be weighed and have their weights recorded on the exam form. Rechecks do not need Schirmer tear tests, fluorescein, or pressure checks unless they are indicated by the patient’s condition (e.g. KCS.)
CERF Exams The Canine Eye Registration Foundation exam is intended to detect heritable eye disease before breeding; it is not intended for patients with an active eye problem. Usually these appointments are seen on a Tuesday or Thursday by a faculty member not on clinics, but occasionally one or two may show up in a recheck slot. They do NOT need any of the standard paperwork (history/PE/ophthalmic history and exam). The client should fill out a CERF form (bubble sheet) for each dog, and the dogs should have their PLRs checked before dilating with tropicamide. You do not need to do any exam.
Tonopens Wait until you have been shown how before using the tonopens to measure an intraocular pressure. The tonopens need to have their covers on at all times to protect them from dust and grit. DO NOT put them back in their cases without the covers!
Ophthalmology shares the surgery ward. All supplies and technical help (for drawing blood, for instance) should come from there. Our patients are hospitalized together with the soft tissue cases. Don’t use supplies or assistance from the medicine ward unless a clinician or technician asks you to. The ophthalmology or surgery ward technicians will help you with finding your supplies, patient restraint, etc.
At the end of the receiving day, we will meet to finish the physical exams, to check on lab work and anesthesia/surgery requests submitted, and to round and review the cases seen during the day as time permits.
RECORD KEEPING
The veterinary medical record is a legal document and a permanent record of the patient’s stay in the hospital. It also plays a large role in the faculty’s evaluation of the student’s knowledge and understanding of the medical problem. The format for the medical record is the Problem Oriented Veterinary Medical Record, using the SOAP format for each problem identified. The SOAP should be completed by 8AM, but may need to be updated as things change during the day.
Student ophtho forms are available for you to use as “scratch paper” in the exam rooms. Please do NOT write or draw on the pictures on the ophthalmology exam form! (The clinicians use this space to record their exams.)
Ophthalmology has its own VetStar discharge form. Discharges should include a brief description of the reason for presentation, our findings, and a list of problems for the client to watch out for (redness, squinting, cloudiness, discharge). Our service uses a separate form to communicate with the referring veterinarian, so the discharges are written to be comprehensible and useful to the client. Make sure the correct doctor’s name is in the signature block at the bottom; use the “Insert Text” button to enter their information.CASE MANAGEMENT
Students are responsible for all aspects of their patient’s care.
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You need to come in early enough in the morning to have time to take your patient outside, do its TPR, and complete its SOAP before the agreed meeting time. SOAPs need to be finished by 8AM. Treatments need to be listed in the SOAP. Check to make sure that they are recorded on the treatment sheet as well.
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Students are responsible for treatments of large animal patients between 8AM and 6PM. The surgery ward technicians will do small animal treatments during the day. You will need to talk directly to the evening ward student about the case and explain how to do the 6PM to 12 AM treatments. Patients who need intensive or overnight treatments may be admitted to CCU.
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Be on the look out for laboratory test results for your patients.
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If there is a possibility that your case is surgical, please submit the anesthesia/surgery request as early as possible. (Anesthesia will be happy if we cancel a case; they won’t be happy if we add one on late in the day.)
SURGICAL CASES
If your case is the first one scheduled for the day, you will be responsible for taking the patient and the medical record to anesthesia recovery about 45 minutes before the scheduled induction time. Surgical patients require a 3-point check before any clipping or prepping – verify which eye requires surgery by checking the record, with the technician, and with the clinician. This is especially important in the case of enucleations. The ophthalmology technician will prep most surgical patients – check to see what is required.EMERGENCY DUTY
The emergency duty sign-up will be in the surgery ward on the first day of the rotation. Be sure that your home phone and pager numbers are recorded on the sign-up sheet. Keep your pager turned on all the time, even when you are at home, because the front desk will NOT call your home number. THEY WILL ONLY CALL THE PAGER.CLIENT HANDOUTS
There will be a brief client handout due on each Friday afternoon of the rotation. Choose any ophthalmology topic you like, but try to pick something that will be manageable in a one-page format. The purpose is to summarize a topic in a way that will be useful for a client. (See the example sheet for guidance.)GRADES
Grades will be reported on the A-S-D-F system, and will be based on performance and improvement over the course of the rotation.
Please send any comments or questions to shermank@svm.vetmed.wisc.edu. Last modified on June 22, 2003 by Kim Sherman.
