1. Guessing weight.
Hey, that big dog is having a seizure! No time to get it on the scale. Instead, you guess, as in:
That looks like a 45 kilogram dog = 4.5 ml Valium (0.5 mg/kg, 5 mg/ml).
Also useful when you're tapping the sweet Golden's pericardial effusion and she goes into vtach:
That looks like a 30 kilogram Golden = 3 ml lidocaine slowly until she converts (2 mg/kg, 20 mg/ml).
You can also guess weight in multiples of cats. A medium-sized cat is 5 kilograms (12 pounds), so you go:
That dog looks like about the size of 7 cats = 35 kilograms.
2. The ghettecho.
Let's say it's the middle of the night, you have a patient with shitty cardiac output, and an ultrasound. With a little bit of knowledge, you can get yourself a lot of information:
- First, make sure your patient can breathe! Oxygen and sedation are your buddies.
- Once you've sort of stabilized and administered oxygen, Lasix, torb, or other drugs as needed, do a physical. Think about mucous membrane color, lung sounds (are there crackles? wheezes? are they...suspiciously dull or absent?), heart sounds (murmur? arrhythmia? can't hear the heart?), pulse quality (weak? thready? waterhammer? pulsus paradox?), etc.
- Chest x-rays would be pretty great, but your patient might not be stable enough for those yet. You can usually ghettecho while your patient sits or stands in a comfortable position, and you can totally do it through the oxygen cage porthole if needed.
- If your ultrasound has a cardiac preset or probe, use that.
- Figure out how to adjust your depth and gain settings.
- Find the heart with the ultrasound. Sometimes (especially if your patient is hypovolemic) this is harder than you think.
- Is the heart surrounded by a bag of fluid? Heeeey, pericardial effusion! Tap that! (caveat - sometimes you can be faked out by pleural effusion, which looks more like it has sharp corners on flash).
- Okay, next check out left atrial size. You don't need to actually measure it, but is it way bigger than the aorta? Lasix!
- Finally, find the short axis view, and look at ventricular function. The big muscular one is the left ventricle - does it look like it's adequately contracting to move the fluid inside it? If it looks like the walls move towards the center just a little bit, your patient's fractional shortening may be sub-optimal. If the right ventricle (the smaller, curved-around-the-big-muscular-ventricle one) looks really full, think about right heart failure.
- While you're there (if the patient is stable enough), check out the pleural space and the abdomen for free fluid.
The ghettecho is not as useful as a legitimate cardiologist or radiologist echo in any sense of the word, but it does have its place as a middle-of-the-night rough gander at heart function.
3. Euthanizing a wide variety of wildlife.
Ever done an intracardiac stick on a severely injured baby bunny or a tiny bird with a broken leg? It'll make you feel like a terrible person.
4. Standing high jump.
If your patient is larger than a medium-sized cat (see above) or if you are shorter than ~5'10'', you're gonna need to get on the table to do good chest compressions during CPR.
The fastest/least awkward way to do this (the CPR stool is never actually with the crash cart) is to put your hands on the table (while someone else is doing the compressions), vault onto the table in one jump, land (gently) on your knees, and take over.
5. Hitting a moving, challenging target.
You know what's fun? Intubating a healthy dog in sternal recumbency who has just gently drifted to sleep after receiving modest amounts of pre-meds and propofol.
You know what's less fun? Intubating a dog who has arrested in lateral recumbency while wedged between the crash cart and the technician placing the catheter whose head is moving because of the chest compressions while hemorrhagic fluid pours out of his mouth.