scott@vtx-cpd.com
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Replying to Dan T. 14/07/2023 - 10:53
Thanks Dan.
This is really helpful. To be honest, I think my first task will be to actually find out what the company values are when I am locumimg. If I am being honest, I would not be able to recall what the values were for the last clinical job I had. I am going to be looking in to that. I think being more aware, and making others aware of the company values is a start.
This has also made me think really carefully about the fact that we do not have company values with vtx. We have a directors meeting next week and this is now top of the agenda!
Scott x
Replying to Cristina M. 14/07/2023 - 12:13
No problem.
Questions seem to create more questions! In a good way!
Scott 🙂
I agree!
Such a simple thing bust so important.
I am just about to start doing so locum clinical work and made sure to have my name embroidered on my scrubs (something I would never thought to have done before!).
Again, such a simple thing but makes all of the team members feel valued. I also think it is important not to forget EMS students and students generally. We were all there once and they must not be forgotten.
Thanks again for sharing.
Scott 🙂
Replying to Dan T. 13/07/2023 - 20:29
This is really interesting Dan.
Thank you for such detailed answer. I will spend some time considering my own values. I also think that we need to do this as a company at vtx, so we will look at this together as a group too.
I think the main point for me is concerning the company values and how they are determined. The need to feel lived and authentic. I seems the best way of doing this is to involve as many of the team as possible in the decision making! I have a few more questions:
1. If we are working for a big corporate with central core values, is it wrong to come up with a clinic specific set?
2. What about individual team values? Even as part of a bigger hospital, do you think it is appropriate for individual departments to have a set of values, or is this too divisive?
Thanks again.
Scott 🙂
Replying to Helen S. 12/07/2023 - 16:35
Thank you so much for this Helen.
Thank you for taking such time and consideration with this answer, I really appreciate that.
This all makes a lot of sense. The examples of core values that you have given are also really helpful.
I would say the Huel’s number 2 is also my favourite… I think if I could only chose one it would be that.
Thanks again.
Scott 🙂
Replying to Cristina M. 13/07/2023 - 13:47
Hello Cristina!
Thank you so much for joining us and congratulation on your new role.
It is lovely to see people joining us all the way from Italy. I hope you are keeping safe in the heat!
Scott 🙂
Hey Helen!
Thank you so much for sharing this, I will look forward to having a listen.
I know this is less about leadership specifically, but I love Stephen Bartlett’s “The Diary of a CEO” podcast:
Thanks again for sharing.
Scott 🙂
Replying to Darlene G. 12/07/2023 - 17:06
Hello Darlene,
Lovely to hear from you! I hope you are enjoying the course.
I agree, the jugular vein is indeed the one that you will get the best sample from. However, I would avoid using the jugular in severely thrombocytopenic patients. I would use the cephalic for these samples as a pressure dressing can be applied afterwards.
A bit of a compromise I think!
Scott 🙂
Replying to Liz Bode 06/07/2023 - 19:57
Thanks pal.
Really helpful. I have a funny feeling you might have actually scanned this patient?!
I will share what we did next!
Scott 🙂
Replying to Kathryn B. 06/07/2023 - 20:59
Thanks.
I would agree, the DM may not be that well controlled at day 23… but I question how well we ever really control DM in dogs and cats at the best of times (a debate for another day!).
The BG are actually not that interesting here. The PCO2 could be decreased due to some thing simple as panting. No major pH changes so I would not be too concerned.
I think the holter is a good shout. I will share what we did next.
Scott 🙂
Hello Nadia.
Thank you so much for reply. Brilliant, there are indeed lots of signs of fragmentation injury to the red blood cells.
I have copped part of the smear report from the pathologist below:
“Microscopic Description
A single blood film is examined. The history reports a moderate acute anaemia, icterus, and suspected
immune-mediated haemolytic anaemia.Platelets: platelets of variably distributed across these films and rare small platelet aggregates identified,
precluding definitive assessment of numbers. Morphology appears unremarkable.Erythrocytes: Anisocytosis +. Polychromasia +. Echinocytes +. Acanthocytes + Schistocytes +. Keratinocytes
Spherocytes +. Occasional metarubicyte. Rare erythrocytes. Occasional ghost cells.Leukocytes: Dohle bodies +. Occasional neutrophils demonstrate mild cytoplasmic basophilia. Rare band
neutrophils are identified. The analyser differential is confirmed and morphology appears unremarkable.”So… A mixed bag really! There are low numbers of spherocytes and ghost cells. While the latter may be artefactual, depending on sample age, this keeps the possibility of immune mediated destruction on the table. However, low numbers of spherocytes are slightly non-specific and therefore in saline agglutination at 1:50 or Coomb’s testing could
be considered for further clarification. The remaining erythrocyte changes may be observed with increased
erythrocyte fragmentation injury, but also with altered erythrocyte membrane phospholipid composition for
which differentials include renal or hepatic disease. Fragmentation can occur because the red blood cells are being damaged as they travel through the vasculature (e.g. being sheared through fibrin clots in disseminated intravascular coagulation; DIC) or they are mechanically fragile (e.g. iron deficiency anaemia). In these situations, acanthocytes are frequently accompanied by other red blood cell changes, indicative of fragmentation injury, i.e. schistocytes and keratocytes.We did perform an in saline agglutination which was negative and we then performed a Coomb’s which was also negative.
Full abdominal ultrasound was performed and revealed a 3cmx4cm splenic mass. No free fluid was detected.
What would be your next steps?
Scott 🙂
Replying to Victoria Rubasinska 10/07/2023 - 22:32
Hello Victoria!
Lovely to see you here! I am really glad you enjoyed the first lesson. It is great to hear you have picked up some top tips already!
Let us know if you have any questions.
Have a great week.
Scott 🙂
Replying to Nadia C. 09/07/2023 - 12:42
Brilliant!
Maybe our paths will cross! Thank you again for the great questions.
I really hope you are enjoying the course!
Scott 🙂
Replying to Nadia C. 08/07/2023 - 22:15
HAHAH!
This makes sense now. If you are working in a centre that has a TEG machine, then they will consider this gold standard. Overall, TEG is the only way to assess global coagulation. Many centres do not have access to TEG and therefore it is still very reasonable to look at PT and aPTT. So neither Pride or Paragon are wrong, they simply have different kit. I have worked in many clinical situations where PT and aPTT are totally acceptable.
How interesting that you work at Paragon… I am actually doing a locum there in a few weeks! We must say hello!
Scott 🙂
Replying to Nadia C. 08/07/2023 - 22:29
Hello Nadia.
Thank you for your response. I agree, practically we also take blood from the catheter at the time of catheter placement. We will then be using those catheters for multiple IV infusions/IV lines. We would then normally take repeated blood samples from the jugular vein. It think it is less practical to take a blood sample from a peripheral catheter when it has been in for a few days. The exception would be if we have a central line in place. The great benefit of central lines is the ability to take repeated blood samples.
Really interesting that you work as an in patient vet. That must be quite a rewarding role?
Scott 🙂
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