OSCE practice

OSCE practice VSDI01 Skull Radiograph - ANS Central: on top of cranium Rostrally: tip of the nose Caudally: occipital crest Laterally: skin edges VSDI02 - Lateral Abdominal Radiographs - ANS Central: Cranial Abdomen Cranially: Diaphragm Caudally: Umbilicus D/V: Skin edges VDSI03 - BVA Hips - ANS Centre: Pubis Synthesis Cranially: Wings of Illium Caudally: Shaft of femur Laterally: Skin edges VSDI04 - Thoracic Radiographs Right Lateral - ANS Centrally: 5th Rib Cranially: Thoracic inlet Caudally: Last Rib D/V: Skin edges VSDI05 - Radius & Ulna Radiographs Mediolateral Left - ANS Centre: Mid Radius/Ulna Proximally: Olecranon Distally: Carpus Cranio/caudal: Skin Edges VSDI06 - Lumbar Spine Radiograph Right Lateral - ANS Centre: Mid Lumbar Spine Cranially: Thoraco-Lumbar Junction Caudally: Lumbo-sacral junction Laterally: Dorsal skin edges and ventrally to mid abdomen VSDI07 - Lateral Right Elbow Radiograph - ANS Centre: Elbow Joint Proximal: Distal 1/3 of humerus Distally: Proximal 1/3 of radius/ulna Cranial/Caudal: Skin Edges VSDI08 - Caudocranial Stifle Left - ANS Centrally: Stifle Proximal: Distal 1/3 of Femur Distal: Proximal 1/3 of tibia/fibula Medial/Lateral: Skin Edges VSDI09 - V/D Abdominal Radiograph - ANS Centrally: Caudal Aspect of Abdomen Cranial: Last Rib Caudal: Ischium to include urethra Laterally: Skin Edges VSDI10 - DV Thorax - ANS Centrally: Midline of caudal border of scapular Cranially: Thoracic Inlet Caudally: Last Rib Lateral: Skin Edges VSDI011 - Ultrasonography clip - ANS Cranially: Xiphoid process Caudally: Midway between umbilicus and pubis Laterally: from Xiphoid Process up and around costal arch until midway up the flank PCV Range Cat - ANS 25-45% PCV range Dog - ANS 35-55% Specific Gravity Cat - ANS 1.020 - 1.050 Specific Gravity Dog - ANS 1.015 - 1.045 Circuit factor t-piece - ANS 2.5 - 3 Circuit Factor Lack - ANS 1 - 1.5 Fresh gas flow rate - ANS TV x MV x CF Total Protein ranges - ANS 60-75g/l VSA01 -Anaesthetic Machine 10kg - ANS 1) TV x MV x CF 2) Select Ayres T-piece 3) Check 02 cylinder, open (mauy need a key 4) Mark as "in use" on 02 cylinder 5) Move bobbin on 02 flow meter and leave for a few seconds 6) Check amount of ISO and comment 7) Check emergency flush 8) Leak test machine - 02 up to 4L and occlude FGF outlet and if bobbin DROPS = NO LEAK 9) Scavenger in floor 10) Attach Circuit 11) Close APL Valve 12) Gently Press emergency flush and check bag and comment 13) Open APL valve & hang circuit VSA02 -Anaesthetic Machine 10kg - ANS 1) TV x MV x CF 2) Select Lack (less FGF required due to lower CF & kinking/blockage easily seen) 3) Check 02 cylinder, open (mauy need a key 4) Mark as "in use" on 02 cylinder 5) Move bobbin on 02 flow meter and leave for a few seconds 6) Check amount of ISO and comment 7) Check emergency flush 8) Leak test machine - 02 up to 4L and occlude FGF outlet and if bobbin DROPS = NO LEAK 9) Scavenger in floor 10) Attach Circuit 11) Close APL Valve 12) Gently Press emergency flush and check bag and comment 13) Open APL valve & hang circuit VSC01 - BVA Hips admit - ANS 1) Check consent form & prepare ID collar and slip lead 2) Invite patient in 3) Name & address, Animal age (1year+) weight, Microchip, Vaccination status, Health (EDUF), Current medications, KC paperwork, Normal routine (Toilet commands/litter, food, last ate, behaviour) 4) Explain procedure (GA, Radiographs) 5) Make sure understood 6) Time to read and sign consent form 7) Check all details are correct 8) 2 phone numbers 9) Ask if any questions 10) Likely time to collect/be updated 11) Scan Microchip, apply ID collar and slip lead MUST GIVE THEIR COLLAR BACK 12) Client to go back to reception **Any order** VSC02 - Infectious case admit Cat - ANS 1) PP, check consent form, prepare basket and ID collar 2) Invite patient in 3) Check, name & address, animal age, weight, microchip, vaccinated, health and medication, normal routine (litter, food, behaviour) 4) Explain hospitalisation, IVFT and diagnostic urine/bloods 5) Client reads and signs consent form, 2 numbers to call on, likely update time, check all correct 6) Client understands everything and ask if any questions 7) ID collar on cat re-assuringly, place cat in practice basket 8) Client back to reception 9) Explain to Vet that patient is in isolation due to unvaccinated 10) Remove PPE VSC03 - Dog Castration Discharge - ANS 1) Check discharge sheet and medication to go home with 2) Invite patient in & explain you'll get the dog after discussing home plan 3) Explain GA and castration 4) Describe wound (small surgical incision) and wound care (visual signs, swelling etc) 5) Strict exercise regime, rest, no jumping, short walks on lead for 1 week 6) Give them the Elizabethan Collar or tell to purchase one 7) Explain patient ate a small amount abut to have a light dinner and water 8) Discuss medication (when to start, how to give, which route, potential side effects) 9) Discuss importance of post-op check with vet/rvn - book this appointment and give card 10) OOH information card 11) Any questions 12) Go back to reception and you'll bring their pet out VSDSQP03 - Prescription dispensing - ANS 1) Greet Client & receive prescription 2) Confirm: Name and address, animal details, date of prescription and signature of Vet 3) Ask if any issues using this medication or any changes to the animal since last Vet visit 4) Give a brief over-view of the medication, side effects etc 5) Prepare medication: correct product, in date, strength and count into bottle twice 6) Prepare label: Practice + Owner's name and address, Patient, Quantit, strenght and dose, name of drug, "KEEP OUT OF REACH OF CHILDREN" "FOR ANIMAL USE ONLY", expirary and batch numbers 7) Initial the label and ask for a counter initial from the "Vet" 8) Give medication to client and explain routes of administration 9) Retain the prescription and record the information on the history 10) Ask client if they are happy VSLT01 - Blood Sample and Package - ANS 1) PPE 2) Equipment needed: 21G needle, 2ml syringe, CHlorhexidine swab AND spirit swab, Swab for POST Venepuncture (pressure swab), Blood tube (lithium heparin/serum gel) and artery forceps 2) Aseptically prepare needle & syringe 3) Ask for restraint - explain how 4) Raise vein and feel for it 5) Circular motion clean with Chlorhexidine first and then spirit 6) Remove cap from needle and dispose and take sample 1.5ml worth 7) Apply plain swab for pressure and pull out 8) Remove needle with artery forceps into sharps bin 9) Fill blood to line in tube WITHOUT TOUCHING THE SIDES 10) Dispose of syringe in orange lidded bin if available 11) Ask to stop restraining after checking venepuncture site and to keep a hold of the patient 12) Label sample (Name, surname and date) 13) Correctly fill in lab form (biochemistry) 14) Place form in polythene bag or outer section of biohazard bag 15) Ensure lid is tight on the tube, wrap in cotton wool, bubble wrap and into the biohazard bag, remove air and seal, place bag in padded envelope and into specific area for collection 16) Clean area of rubbish and take off PPE (maybe before using a pen) VSLT02 - Urinary cather and SG - ANS 1) PPE on 2) Equipment: Measuring cylinder, paper towel, clinical waste bin, pipette/syringe, distilled water and hospital sheet 3) Approach patient friendly - ask for restraint if needed if not maintain that the patient is safe inside the kennel 4) Check catheter site and vocalise condition (e.g clean, no erythema) 5) Run the paper towel dowen the length of the CLOSED systems to ensure no leaks 6) Empty urine bag into measuring cylinder using the valve 7) Close the valve once empty and ensure no blockage 8) Measure the volume of liquid and consider: smell, colour and turbidity 9) REMOVE GLOVES 10) Record results on hospital sheet 11) Clean gloves and calibrate refractometer using distilled water and wipe clean 12) Swirl urine gently and pipette a small amount onto prism 13) Observe reading 14) Dispose of waste and distilled water onto the prism over clinical waste bin with paper towel in the bottom 15) Dispose of PPE 16) Record USG on the hospital sheet including time, date and initials KK VSLT03 - PCV - ANS 1) PPE on 2) Equipment: Centrifuge, EDTA tube, Plain microhaematocrit (capillary) tube, clay tray, paper towel and hawksley microhaematocrit reader 3) Switch on centrifuge, open lid, unscrew metal cover and check it is clean 4) set to 10,000 RPM for 5 mins 5) Invert EDTA blood sample 6) Hold capillary tube at an angle to fill 3/4 way place a finger over the end, wipe clean, into clay to plug it and remove finger x2 to balance centrifuge 7) Place tubes oppoisite each other (plug end towards edge) 8) Screw metal colver on and inform "vet" that the sample is ready to be spun 9) Use the provided tube to read: clay is at 0%, end of plasma is at the top line and read the middle layer - read on right hand side 10) record on hospital sheet and tell Vet is it normal/abnormal 11) Dispose of waste and PPE VSLT04 - Total Solids - ANS 1) PPE 2) Equipment: Blood tube selection (lithium heparin/serum gel), distilled water, paper towel, refractometer and pipette 3) Calibrate refractometer & wipe clean 4) Pipette a small amount of plasma onto prism and read 5) Rinse with distilled water in clinical waste bin with paper towel in & Wipe dry 6) Dispose of waste and PPE 10) Record on hispital sheet, units (g/100ml x 10 to get L) 11) Include date, time and initials KK READ ON LEFT HAND SIDE VSLT05 - Parasite Identification and Vernier Scale Reading - ANS 1) PPE on 2) Microscope OFF, Lower Rheostat (light source) to minimum and rack the stage down, adjust condenser to a couple of mm below the stage, adjust eye piece and choose lowest lense x4 3) Place slide onto microscope stage with parasite directly under line of lense 4) Whilst looking at the stage (crouch down) rack it up 5) Turn ON microscope 6) Adjust Rheostat and fine focus until it is in view **Use battlement technique if required to locate it** 7) Identify the parasite (may be visable on microscope or a picture may be shown to you) 8) Take and record the Vernier Scale Reading REMEMBER THE HORIZONTAL AND VERTICAL READINGS 9) Remove PPE and record readings VSNCIC01 - IVFT Canine - ANS Isotonic saline solution is 0.9% Sodium Chloride 1) Get the right fluids, check date and appearance and giving set 2) Open outer package and hang on drip stand and open giving set 3) Close flow controller (roller) on giving set 4) Remove the cover from the port on the drip bag carefully (snap or twist) 5) Holding port above opening, insert spike of giving set 6) Half fill the chamber 7) Gently open roller clamp to allow fluid to run through **SLOWLY NO AIR BUBBLES** 8) Once no air bubbles, close the roller clamp and hang (keep end cap on if possible) 9) Calculate daily requirements Daily, Hourly, Minute and drop factor (20) VSNCIC02 - Post Surgical Forelimb Bandage Canine Post Mass Removal - ANS Right Cranial mid antebrachium wound (between elbow and carpus) 1) PPE and look at photograph and assess the wound (clean surgical) 2) Equipment: Melolin (low adherent and low absorbent), softban, co-flex, conforming, cotton wool, scissors 3) Open all material 4) Ask for restraint - Left Lateral 5) Pad the toes 6) Initial dressing (melolin in a pinch method) 7) Softban, 50% overlap 8) Conforming 50% overlap 9) Co-Flex 50% overlap (consider tension) 10) Cut bandaging material DO NOT TEAR 11) Ensure all padding is covered and dressing is neat 12) INCLUDE FOOT AND ABOVE ELBOW 13) Two fingers at the top to check tension 14) Dispose of PPE and waste VSNCIC03 - Post Surgical Hindlimb Bandage Canine Post Debride and Suture of wound - ANS Left hind plantar surface proximal to metatarsal pad wound 1) PPE and look at photograph and assess the wound (clean contaminated) 2) Equipment: Melolin (low adherent and low absorbent), softban, co-flex, conforming, cotton wool, scissors 3) Open all material 4) Ask for restraint - Right Lateral 5) Pad the toes 6) Initial dressing (melolin in a pinch method) 7) Softban, 50% overlap 8) Conforming 50% overlap 9) Co-Flex 50% overlap (consider tension) 10) Cut bandaging material DO NOT TEAR 11) Ensure all padding is covered and dressing is neat 12) INCLUDE FOOT AND ABOVE HOCK 13) Two fingers at the top to check tension 14) Dispose of PPE and waste VSNCIC04 - IVFT for Rabbits - ANS Hartmanns/Lactated Ringers solution 1) Get the right fluids, check date and appearance and giving set (paediatric 60dps/ml) 2) Open outer package and hang on drip stand and open giving set 3) Close flow controller (roller) on giving set 4) Remove the cover from the port on the drip bag carefully (snap or twist) 5) Holding port above opening, insert spike of giving set 6) Half fill the chamber 7) Gently open roller clamp to allow fluid to run through **SLOWLY NO AIR BUBBLES** 8) Once no air bubbles, close the roller clamp and hang (keep end cap on if possible) 9) Calculate daily requirements Daily, Hourly, Minute and drop factor (60) VSNCIC05 - Forelimb splin and bandage for Canine RTA first aid - ANS Right Radius and Ulna, wounds on cranial carpal area (patient is conscious) 1) PPE and look at photograph and assess the wound (Contaminated? any exudate/bleeding?) 2) Equipment: Allevyn (exudat), softban, co-flex, conforming, cotton wool, scissors, gutter splint good length including carpus and elbow 3) Open all material 4) Ask for restraint - Left lateral/standing 5) Pad the toes 6) Initial dressing 7) Softban, 50% overlap 8) Splint 9) Conforming 50% overlap 10) Co-Flex 50% overlap (consider tension) 11) Cut bandaging material DO NOT TEAR 12) Ensure all padding is covered and dressing is neat 13) Two fingers at the top to check tension 14) Dispose of PPE and waste VSNCIC06 - Right Forelimb Bandage Canine with Exudative would to R Lateral Metacarpus - ANS Exudative wound Right Lateral Metacarpus, Drug resistant!!! 1) PPE & ask assistant to wear PPE and look at photograph and assess the wound (contaminated or infected) 2) Equipment: Choose appropriate dressing, softban, co-flex, conforming, cotton wool, scissors 3) Open all material 4) Ask for restraint - Left Lateral 5) Pad the toes 6) Initial dressing 7) Softban, 50% overlap 8) Conforming 50% overlap 9) Co-Flex 50% overlap (consider tension) 10) Cut bandaging material DO NOT TEAR 11) Ensure all padding is covered and dressing is neat 12) INCLUDE CARPAL JOINT 13) Two fingers at the top to check tension 14) Dispose of PPE and waste VSNCIC07 - Chest Bandage for Feline following RTA - ANS Patient is SEDATED, Right Lateral Thorax Wound 1) PPE and look at photograph and assess the wound (Contaminated? Bleeding etc) 2) Equipment: Allevyn (choose adhesive if possible), softban, co-flex, conforming, cotton wool, scissors 3) Open all material 4) Ask for restraint - gentle lifting left lateral 5) Pad the toes 6) Initial dressing 7) Softban, 50% overlap 8) Conforming 50% overlap 9) Co-Flex 50% overlap (consider tension) 10) Cut bandaging material DO NOT TEAR 11) Ensure all padding is covered and dressing is neat 12) Check patient is comfortable breathing INCLUDE SHOULDERS 13) Two fingers at the top to check tension 14) Dispose of PPE and waste VSNCIC08 - IV Cannula for canine patient (calculation as well) - ANS 1) WHO Hand wash 2) Equipment: 20G cannula (check date & condition), Chlorhexidine and spirit swabs (seperate), Surgical Tape, Sterile cannula bung, Softban & Co-Flex, Clippers with SIZE 40 BLADE (check condition, plugged in and attach blades) GLOVES 3) Calculate dose of medication (mg/kg / mg/ml) 4) Correct medication selected by checking broach date, expiary date and strength 5) Spirit swab to wipe bottle top 6) Aseptically prepare syringe and needle 7) Dispose of waste 8) Make sure all paperwork is correct including units, working out on hospital sheet DO NOT DRAW UP MEDICATION OR GIVE IT VSNCIC09 - Emergency Care - triage to unresponsive puppy - ANS 14kg Puppy is unresponsive 1) PPE 2) Position in lateral 3) Stethoscope, eye torch equipment if there 4) PRIMARY SURVEY: A] Airways - Clear? Open mouth and comment B] Breathing - Are they breathing? Watch chest, hear sounds? C] Circulation - Stethoscope to hear heart beat, central pulse? Peripheral pulse? Colour of MM, CRT? N] Neurology - Talk to them - is there a respinse, eye torch to check if pupils respond correctly, eye position? 5) Note down everything 6) Relevant history from the owner: What/When/How did this happen, Eaten anything suspicious? Recently unwell? Current medications? Anything dangerous surrounding patient? MAKE NOTES AS THEY SPEAK 7) Name and number of client, basic information - name age of patient 8) Ask to wait in reception whilst you speak to the "Vet" 9) Relay information back to the vet of findings (medical terminology used here) VSNCIC10 - CPR on canine - ANS 36kg Elderly Labrador with cardiac arrest, ET tube is being placed, Lateral recumbency on the floor is most likely appropriate 1) SECURE ET TUBE 2) Ensure cuff is inflated 3) Safety check Ambu-Bag (Squeeze to make sure it inflates, feel for expelled 02, occlude the outlet and squeeze and check the pop off valve lifts (no leak) 4) Attach AMBU-BAG to ET tube 5) Give ONE breath every SIX seconds (10 breaths/min) AFTER TWO MINUTES EXPLAIN TO VET YOU WILL SWITCH PLACES AND EXPLAIN THIS 6) 100 compressions/minute, highest part of the chest DO THIS FOR TWO MINUTES VSNCIC11 - S/C injection to canine with pseudomonas - ANS 1) PPE and ask assistant to do the same 2) Calculate medication (mg/kg / mg/ml) 3) Prepare Equipment: Syringe, 2x21G needle, Swab with surgical spirit, drug bottle checking strength, broach and expirary date, sharps bin, pharmaceutical bin 4) Aseptically prepare syringe and needle 5) Invert the drug bottle checking it for debris 6) Swab top of bottle with prepared spirit swab 7) Draw it up yo 8) Discard needle with forceps and put new one on 9) Place in dish to be checked - EXAMINER WILL PROVIDE AN AIR FILLED SYRINGE TO GIVE 10) Ask for restraint and be specific 11) Administer SC slowly 12) Rub injection site 13) Keep needle pointing down then remove appropriately 14) Dispose of waste and PPE 15) Write on hospital sheet including: Date, time, medication amount and strength, area and route of injection, notes observed e.g patient comfortable, Initials KK VSNCIC12 - I/M injection to Canine with L Hind Cruciate injury (analgesia) - ANS 1) PPE and ask assistant to do the same 2) Calculate medication (mg/kg / mg/ml) 3) Prepare Equipment: Syringe, 2x23G needle, Swab with surgical spirit, drug bottle checking strength, broach and expirary date, sharps bin, pharmaceutical bin, CD register 4) Aseptically prepare syringe and needle 5) Invert the drug bottle checking it for debris 6) Swab top of bottle with prepared spirit swab 7) Draw it up yo 8) Discard needle with forceps and put new one on 9) Place in dish to be checked - EXAMINER WILL PROVIDE AN AIR FILLED SYRINGE TO GIVE 10) Ask for restraint and be specific - Lumbar muscle 11) Administer IM slowly 12) Rub injection site 13) Keep needle pointing down then remove appropriately 14) Dispose of waste and PPE INFECTIOUS 15) Write on hospital sheet including: Date, time, medication amount and strength, area and route of injection, notes observed e.g patient comfortable, Initials KK 16) Return bottle to DD cupboard VSNCIC13 - Gastrostomy Tube RER Canine - ANS Full RER across 6 feeds 1) PPE on 2) RER calculated (30 x kg) + 70 = Kcal/day / 6 = 1 feed 3) Volume of feed calculated (will be on bottle) 4) Equipment: Syringe, wide bore needle, swab with sterile water, clinical waste bin, hospital sheet and white roll 5) 5ML Sterile water aseptically drawn up (remove needle using forceps) 6) Prepare food and drawp up amount in syringe and place in packet 7) Draw up 5ml tap water and syringe back in packet 8) Ask for Restraint 9) Check incision site 10) Remove PEG Cap and swab with sterile water 11) Release clamp slowly give steril water 12) Give food 13) Post food tap water CHECK FOR DISCOMFORT THE WHOLE TIME 14) Replace clamp and cap 15) Dispose of waste and PPE 16) Record hospital chart: Date & Time of food administration, amount of food, pre/post flush amount, type of food, patient observations and initials KK VSNCIC14 - Physical Therapy on Elderly Canine - ANS Right Limb 1) PPE 2) Approach gently and ask for restraint light 3) Effleurage - touch lightly to aid venous return and warm tissues in preparation. Light pressure keeping hands curved and use gentle sweeping motions from bottom up 4) Pretissage - Knead aims to relieve muscle tension. Slowly and gnetly lift the skin in a kneading motion focusing on muscles of leg 5) Passive Range of Motion (PROM) - Hold one hand over the Pelvis and move leg into bent position (5 seconds & repeat a few times) 6) Hold one hand around the Hock with other hand on the bottom of the foot to allow a standing position (push up a little) 5 seconds and repeat a few times 7) Hold one hand over the pelvis and pull/push leg back (hold for 5 seconds and repeat a few times) 8) Perform a few circular motion of the leg in a natural walking position 9) Return to kennel (say this) 10) Dispose of PPE and complete Nursing Care Plan VSTP01 - Close Gowning and Gloving - ANS 1) Assistant opens glove package and gown 2) Place on sterile surface 3) Gown correctly 4) Ask to fasten the neck 5) Sterile gloves put on CLOSED METHOD 6) Gown waist tie secured in aseptic technique 7) Hands clasped above waist VSTP02 - Surgical Hand Preparation and Open Gloving - ANS 1) Sterillium Timer for 90 seconds 2) Hands cleaned using Sterillium method 3) Ask assistant to open gloves 4) OPEN GLOVE 5) Step back and clasp hands above waist VSTP03 - Instrument Set Packaging - ANS 1) Choose correct instruments and equipment from the list 2) Check instruments are fit for purpose and cover sharp tips if necessairy 3) Ensure all ratchets open 4) Drape with swabs and TST strip inside 5) Constentina the drape normally 6) Place inside autoclave pouch with enough room 7) Date and "basic kit" with initials KK VSTP04 - Open gloving and instrumentation - ANS 1) Ask assistant to open gloves 2) OPEN GLOVE 3) Clasp hands above waist 4) Choose the 10 requested instruments 5) Place from LEFT TO RIGHT on the trolly in order 6) Step back and clasp hands to finish ***Only 8 instruments need to be correct*** VSTP05 - Initial Skin preparation of Canine Elective abdominal surgery - ANS 1) WHO Hand Wash Method 2) Wear PPE 3) Prepare Chlorhexidine at 50:50 ration to water using what is provided to measure and keep 4) Choose swabs 5) Soak swabs fully 6) Perform initial skin prep: Clean Hand: Pick swab up from dish and ring out and pass over Dirty Hand: Prepping the abdomen CIRCLES METHOD - Repeat until visably clear and verbalise to examiner 7) Once you think it is clean do one last one to check for any dirt/debris 8) Clinical waste disposed of 9) PPE off VSTP06 - Final Skin preparation of Canine Elective abdominal surgery + Open Gloving - ANS 1) OPEN GLOVE 2) Ask for Chloraprep to be opened for you 3) Release Chloraprep 4) # then Box method to skin edges 5) Should be 30 second contact time IF SOMEWHERE IS NOT COVERED BY THE CHLORAPREP JUST ASK FOR ANOTHER AND APPLY JUST TO THE MISSED AREA (CHLORAPREP CAN BE COLOURED OR CLEAR) 6) Dispose of PPE and Chloraprep in clinical waste ***Always face the chloraprep outwards even on the sides VSTP07 - Caesarean Section Canine preparing theatre table, light and prepare but not perform skin preparation - ANS 1) PPE 2) Clean/Damp dust table or verbalise if not on offer 3) Check instrument packs if available 4) Heat matt - Vet Bed - Inco pad 5) Sandbags and Trough 6) Table titled or wedge where chest would be to take pressure of chest (verbalise this) 7) Check high of table for ease of moving dog from trolley 8) Ask for help moving patient across 9) Place in trough and apply sandbags to limbs to keep forelimbs out of surgical site 10) Check patient is straight (Get down to eye level at end of the table) 11) Check patient is secure with a little wiggle 12) Switch light on and tilt it slightly with the table 13) Position to centre of abdomen where incision will be 14) Push light up away from the surgeon's head/view 15) Move table to an appropriate height