© 2022 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

© 2022 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Learn tips and pearls for ensuring a comprehensive physical exam

Content submitted by Thrive Pet Healthcare, a dvm360® Strategic Alliance Partner

When a patient and their pet parent arrive at your hospital, it is imperative that veterinary technicians and assistants gather a complete history from the client and perform a thorough physical assessment on the patient. With many of us experiencing a high case load in our hospitals and busy being the word that dominates our workdays, it is not uncommon for us to rush through an initial assessment of our patients by obtaining only a few key vital signs when first assessing them, which typically encompasses a baseline temperature, pulse, respiration (TPR). While important parameters, limiting ourselves to a TPR may lead us to missing significant pieces of information about the medical condition of a pet which as we all know can be subtle, yet profound.

The information we obtain and communicate is necessary to the development of a prognosis and treatment plan by the attending clinician. There are additional vital signs that need to be assessed to “paint the complete picture of the patient” for the clinician. Keep in mind that typically, we have only the client’s observations and the physical findings of our patient to lead us in the right direction for prognosis and treatment. Subtle and obscure observations obtained and communicated by the veterinary technician and veterinary assistant can and will affect the outcome of a patient’s presenting complaint. Not only do we provide valuable baseline parameters for future evaluation of trends, but we also provide an opportunity to prioritize and triage those parameters that are most concerning and will often recognize those abnormal parameters before the patient becomes clinical for those abnormalities.

Read on to review and revisit all the components that, when combined, help us obtain foundational information on the condition of our patients.

Gather a complete description of the animal:

A complete history includes origin, environment, diet, medical history, breeding history, vaccination status, and current medication.

Observe the animal from a distance and up close before handling:

Assess attentiveness and reaction to environment. Include the owner’s observation of the patient at home as part of your history, as patient’s LOC and mentation can change upon arrival at the hospital due to stress, anxiety, pain, and a variety of other factors.

Changes in their status can be related to perfusion, changes in intracranial pressure due to trauma, toxicities, metabolic changes, and/or neurologic changes or disease. Getting a baseline evaluation is imperative as a decrease in LOC and/or mentation can indicate an emergency.

Listed below are the descriptions used to describe LOC and behavior. Evaluate the patient from a distance first and then as part of your physical examination, where you can provide stimulus and evaluate their response up close:

Weigh all animals in kilograms. Use a baby scale for animals under 10 kg and a floor scale for those over 10 kg. Keep in mind most drugs are dosed in mg/kg an 1 kg is equal to 2.2 lbs.

Assess heart rate, rhythm/pulse rate, and quality. Every technician should have a good stethoscope and perform auscultation in as quiet an environment as possible with the patient standing and calm (ideally). Place your stethoscope at the apex of the heart, typically where you can feel the heart beat strongest against your hand, on the left side of the thorax at the fifth intercostal space. Auscult ventral (especially in cats) and right side as well. Determine the heart rate by counting the beats in 15 seconds and multiply by 4:

Perform a pulse quality and synchronicity assessment: palpation of a peripheral arterial pulse (both sides); examples are femoral, dorsal pedal, radial, sublingual:

Assess first (ABC) in least stressful environment before any noxious stimuli (temperature, MM, CRT, pulse assessment):

Assess color and hydration status. This provides indication of the blood flow to peripheral tissues.

This reflects perfusion of peripheral tissues at the capillary beds. Apply pressure to the mucous membrane. The MM will "blanch" white as they are pressed and become pink again when pressure is released.

Obtain body temperature via rectal thermometer or axillary (not as accurate and often lower by at least 1-degree Fahrenheit). A fast-reading digital thermometer is preferred, making sure that the probe for the thermometer is in contact with the mucous membrane surface of the rectum or the skin of the axillary region.

Most animals dislike having their temperature taken. Complete the rest of the exam before obtaining a temperature to avoid agitating the animal and making examination more difficult. Do not struggle with an aggressive animal to obtain a temperature. If you are having difficulty taking an animal’s temperature, consult with the veterinarian regarding alternative options.

The rectal and anal area can also be an option for assessing MM color if the gums, conjunctiva, vulva and/or prepuce are not accessible.

Several pain scores are available to classify pain that should be assumed in all patients. Assess both physiologic and behavioral indicators.

Whether conducting a baseline exam on a healthy pet or triaging a sick or injured patient, taking a few extra moments to conduct a complete physical exam can have significant benefits to help with proper assessment of an animal’s condition, and may lead to critically important, possibly life-saving next steps for care.

3 Must-reads on veterinary staff shortages

News wrap-up: This week’s headlines, plus dvm360® welcomes 22 new strategic alliance partnerships

Morris Animal Foundation funds research to accelerate osteosarcoma treatment

Make grooming at home a Fear Free event