Pre-Vet Act 1 - Interactive Script

Setting: ''Vet Clinic Examination Room'' You (the student) appear in a veterinary exam room. A large WINDOW frames the EXAMINATION TABLE in daylight, while various TOOLS are neatly organized on countertops, wall hooks, and in drawers. The DOOR opens - you cannot see very far outside. An ATTENDING VET steps in with empty hands. [[Continue]]

''Attending Vet:'' Good morning! It's your first day of veterinary preceptorship, right? My name is Dr. Ananya Rodrigo - I'm one of the attending veterinarians here. We've got two dogs coming in before lunch - one for a yearly checkup, and another one for a sick visit. They're a miniature schnauzer and a beagle, respectively. You'll be shadowing me today while we get you trained. I'm going to go get our first patient - be right back. [[She leaves.]]

Soon enough, you hear another knock at the door. [[You open the door.]]

Dr. Rodrigo has come in with a patient! Looking at the table, you see as a cheerful and jumpy miniature schnauzer with gray-white fur now stands on the tabling. <style> img { max-width: 100%; max-height: 100%; } </style> <img src=https://www.sidewalkdog.com/wp-content/uploads/2023/11/A-miniature-schnauzer-mixed-dog-breed.png> </div> Dr. Rodrigo faces the dog. ''Attending Vet:'' Oh, look at you! Hello! She turns, looking now directly at you. ''Attending Vet:'' This is a Mini Schnauzer named Beetle. [[Pet Beetle?]]

He yips happily. Good boy! You see a popup window appear to the side of the dog. This will be your hub where you can find what stage of the visit you are in and talk to both the owner and attending vet. You will also find information about the following: 1. Signalment 2. Patient History 3. General Appearance 4. Vital Signs 5. Physical Exam You see the section for "signalment" flash to draw your attention. This is the first stage and it is about to begin. [[Signalment]]

''Attending Vet:'' First, let's check his basic identifying info - also known as “signalment”. //What kind of info are we looking for?// //Popup: Which of these indicators is part of patient signalment?// [[Age]] [[Heart Rate]] [[Sex]] [[Breed]] [[Body Temperature]] [[Moving on...]]

//A correct answer. No comment if chosen.// [[Signalment]]

''Attending Vet:'' Actually, that's not part of signalment. We're looking for basic identifying features, not any vital signs or measurements. [[Signalment]]

//A correct answer. No comment if chosen.// [[Signalment]]

''Attending Vet:'' Actually, that's not part of signalment. We're looking for basic identifying features, not any vital signs or measurements. [[Signalment]]

''Attending Vet:'' Good! Checking those now against the form... A popup window appears: ''Signalment'' ''Name:'' Beetle ''Species: '' Canine ''Age:'' 7 years 2 months ''Weight:'' 15lbs ''Sex:'' Male ''Breed:'' Miniature Schnauzer ''Reproductive Status: '' Neutered ''Previous Medical History: '' None Next: [[General Questions]]

''Attending Vet:'' Wonderful. Second on the list is a quick interview with Beetle's owner - we call this a patient history. //In the list, "Patient History" flashes to draw your attention.// ''Attending Vet:'' Can you ask some questions to the owner? I'll take notes. [[How has Beetle been doing lately?]] [[Have there been any changes to Beetle's diet or food intake?]] [[Have there been any changes to Beetle's drinking habits and urination?]] [[Have you noticed anything unusual, such as vomiting, diarrhea, coughing, or sneezing?]] [[How energetic has Beetle been recently?]] [[Do you have any other concerns?]] [[Finished asking general questions]]

Beetle has been pretty great this year! He's very happy and playful, I haven't really noticed anything out of the ordinary. [[General Questions]]

Well, Beetle is a picky eater, so I have to be careful with what food I buy. But he is definitely eating regularly. [[General Questions]]

No, not that I've noticed. He's drinking from the dog bowl like always. [[General Questions]]

Definitely none of those! Haven't seen anything strange. [[General Questions]]

Beetle has been really playful and jumpy! He loves playing with the neighbor's kids. [[General Questions]]

Nope, I'm just here for the yearly check. [[General Questions]]

''Attending Vet:'' Excellent. Aside from the picky eating, that all sounds pretty usual for a healthy dog. You see the section for "general appearance" flash to draw your attention. This is the next stage and it is about to begin. [[General appearance]]

''Attending Vet:'' I'll start preparing our tools while you examine Beetle's behavior. Dr. Rodrigo lets go of Beetle and starts rummaging around in drawers for a stethoscope and thermometer. Suddenly, Beetle barks and bounds off the exam table! He circles the room - shaking off some of the nerves, maybe? <style> img { max-width: 100%; max-height: 100%; } </style> <img src=https://www.kimballstock.com/pix/DOG/02/DOG-02-NR0076-01P.JPG> </div> While the ATTENDING VET goes to retrieve him, you answer the following questions: [[Behavior]]

//What is the dog behavior's like? ("Mentation")// [[ Normal (bright, alert, and responsive)]] [[Depressed (quiet, alert, and sad)]] [[Obtunded (lethargic, sluggish, and inactive)]] [[Comatose (unresponsive)]]

Correct! Next question: [[posture and gait]]

Are you sure? Does that best describe this dog's behavior? //Wrong answer, try again:// Go back to [[Behavior]].

//Question: How is Beetle's posture and gait?// [[Normal]] [[Abnormal (limping, unbalanced, etc.)]]

''Attending Vet:'' Bright, alert, and responsive, with normal gait. Good! Next, let's have a look at his vital signs. You see the section for "vital signs" flash to draw your attention. Continue to [[Vital signs]]

Are you sure? Does that best describe this dog's behavior? //Wrong answer, try again:// Go back to [[posture and gait]].

''Attending Vet:'' I'll hold him still while you take measurements. Here's the first three we'll need. The popup window populates with a new panel of information. ''Vital Signs'' Respiratory rate: ___ Temperature: ___ Heart rate / pulse: ___ ''Attending Vet:'' Let's start with the easy stuff. Watch his breathing - his chest moves in and out. How many breaths do you count in 15 seconds? Player start a 15-second timer. Report [[counted breaths]].

You count ''six breaths'' by the time the timer ends. //During the actual experience, this would be up to the player to count correctly.// How many breaths were there in 15 seconds? [[6 breaths]] (student answered correctly) [[12 breaths]] (student answered incorrectly)

''Attending Vet:'' Correct! We're counting a breath as one expansion and contraction of the chest. You see a popup appear describing the multiply-by-four step to get breaths per minute. ''Attending Vet:'' Multiply by 4 to get... 24 breaths per minute. Is that within our [[normal range]]?

Not quite. Remember, one breath includes both the expansion and contraction of the chest. //Wrong answer, try again:// Go back to [[counted breaths]].

Is 24 breaths per minute in the normal range? [[Yes.]] [[No.]]

Correct! Move on to [[Temperature]] .

''Attending Vet:'' The normal range is 15-30 breaths per minute. //Wrong answer, try again:// Go back to [[normal range]].

''Attending Vet:'' Great! Okay, let's take his temperature now. Here, take this ear thermometer. You are prompted to grab the thermometer and press it to the dog's ear canal. <style> img { max-width: 100%; max-height: 100%; } </style> <img src=https://images.tapatalk-cdn.com/15/04/21/f00d61bd27cc139765ca5af867fcf859.jpg> </div> It measures a temperature of 100.8 F. ''Attending Vet:'' 100.8 degrees Fahrenheit. How's that sound? Is 100.8°F body temperature in the normal range? [[Too low (hypothermia)]] [[Normal range]] [[Too high (fever)]]

Not quite... The normal range should be between 99.5 to 102.5 degrees Fahrenheit. //Wrong answer, try again:// Go back to [[Temperature]].

''Attending Vet:'' Good! We're well within the range of a healthy temperature. The attending vet holds out a stethoscope. ''Attending Vet:'' Alright, it's stethoscope time. Take this, and use it to listen to Beetle's heart rate. I'll give you a 15-second timer, just like before. You are prompted to wear the stethoscope, then place the diaphragm over the dog's heart (from underneath). ''Attending Vet:'' Timer for 15 seconds... Start the [[timer]]?

Not quite... The normal range should be between 99.5 to 102.5 degrees Fahrenheit. //Wrong answer, try again:// Go back to [[Temperature]].

You hear 30 beats, but an on-screen prompt helps you count. ''Attending Vet:'' That was 30, right? Let's do the math and figure out [[beats per minute]].

There were 30 heartbeats in 15 seconds. What is this dog's heart rate? [[30 bpm]] [[60 bpm]] [[120 bpm]]

Not quite. We only counted the number of heartbeats in 15 seconds. Remember to multiply it out to one minute. //Wrong answer, try again:// Go back to [[beats per minute]].

Good! You got the multiply-by-four correct. ''Attending Vet:'' Okay, 120 beats per minute. Does that sound right to you? Is 120 bpm in the normal range? [[Yes]] [[No]]

''Attending Vet:'' All the vitals seem good! I hope that was pretty straightforward. The final step - a physical exam. On the popup window, "physical exam" flashes to draw your attention. Continue to [[Physical Exam]]

Not quite... Normal range is 90 to 140 beats per minute. Go back to [[120 bpm]].

''Attending Vet:'' Since we're on a tight schedule, I'll just have you do a couple parts of the physical exam. You've got the stethoscope, so let's listen to his lungs first. You are prompted to place the diaphragm to a sequence of locations on the dog's chest. //SFX: Even, clear breathing sounds// Do you hear anything unusual? [[Crackling (rales)]] [[Wheezing]] [[Left and right sounds are uneven]] [[None of the above]]

''Attending Vet:'' I agree. Sounds like perfectly normal lung function to me. Finally, let's see if Beetle is properly hydrated. Proceed to check [[Beetle's hydration]]

I haven't noticed anything like that so far. //Wrong answer, try again:// Go back to [[Physical Exam]].

Are you sure? If a dog is dehydrated, we'd see gums that looked off-color and were visibly dry. //Wrong answer, try again:// Go back to [[Beetle's hydration]].

You are prompted to place a hand to the dog's upper lip, lifting it up. The gums are exposed - they are pink and visibly moistened. ''Attending Vet:'' By examining a dog's gums, we can see how well-hydrated they are. We're looking for signs like color and wetness. How does this look to you? //Question: How well-hydrated is Beetle, based on appearance of gums?// [[Normal hydration]] [[Dehydrated]]

''Attending Vet:'' Yep! We're looking for pink, moist gums - not too different from our own mouths. The popup window chimes as all the steps are complete. ''Attending Vet:'' Great work taking care of Beetle here. Dr. Rodrigo talks to the owner now. ''Attending Vet:'' (Name), do we have your permission to do annual bloodwork for the dog? ''Owner:'' Yes, go ahead! I'll head back to the waiting room. ''Attending Vet:'' Okay, we've got another dog coming in right now - it's the sick beagle. Sit tight, and I'll be right back. Dr. Rodrigo [[leaves]].

You hear knocks at the door. ''Attending Vet:'' Coming back in with patient #2! This is our sick visit this morning. [[You open the door again.]]

You see a beagle enter the room with a sluggish gait, panting and occasionally coughing. <style> img { max-width: 100%; max-height: 100%; } </style> <img src=https://media.istockphoto.com/id/1600536192/photo/sad-dog.jpg?s=612x612&w=0&k=20&c=7Fx3C1H6PIGi7PXwAYQvgzDj6E4v_uoqAPPhghBFwmA=> </div> ''Attending Vet:'' This is Abby, a female beagle, coming in for a sick visit. Let's check her identifying info - the signalment. The popup window once again comes up. Signalment flashes to catch your attention again. [[Go to signalment]].

''Signalment'' ''Name:'' Abby ''Species:'' Canine ''Age:'' 4 years 6 months ''Sex:'' Female ''Breed:'' Beagle ''Reproductive Status: '' Spayed ''Previous Medical History: '' None ''Attending Vet:'' Yep, that all looks right. Let's talk to the owner and figure out what's going on. Abby here looks rather unwell. In the popup window, patient history flashes, catching your attention again. ''Attending Vet:'' Can you ask the questions again? I'm taking notes. Go and ask the owner some [[questions]].

[[How has Abby been doing lately?]] [[Have there been any changes to Abby's diet and food intake?]] [[How about her drinking habits and urination?]] [[Have you noticed anything such as vomiting, diarrhea, coughing, or sneezing?]] [[Have there been any changes to Abby's environment recently?]] [[What about Abby's day-to-day energy levels?]] [[Finished asking questions.]]

''Owner:'' Well, around a week ago, Abby started coming down with a cough. Since then she's seemed really sick and sluggish. I was hoping it would clear up but she's been like this for at least six days. Ask more [[questions]].

''Owner:'' Yes, Abby has been eating way less since she got sick. I have to really coax her into doing anything other than moping around. Ask more [[questions]].

''Owner:'' Yes, she's drinking less too. Ask more [[questions]].

''Owner:'' Take a listen - she's coughing right now! The beagle coughs. ''Owner:'' None of the others, though. Ask more [[questions]].

''Owner:'' Not that I'm aware of. We do the usual things - walks in the mornings, occasional dog park visits. We also go hiking on Saturday mornings. So, no, I wouldn't say anything is different than usual. Ask more [[questions]].

''Owner:'' Like I said, she's been really slow and mopey since she fell ill. She can walk just fine, but just prefers to lay around.

''Attending Vet:'' Okay, there's a lot of info here. Based on her answers, what stands out to you? We'll need to check these during our physical exam. [[Multiple-select question]]

A multiple-select question, with checkboxes. ''Correct answers:'' [[Not eating and drinking enough]] [[Respiratory issues]] [[Hyperactive, aggressive behavior]] ''Wrong answers:'' [[Sign of injury (limping, localized pain)]] [[Skin and fur irritation]] [[Vomiting / emesis]] [[Move forward with evaluation.]]

''Attending Vet:'' Correct! What else? [[Multiple-select question]]

''Attending Vet:'' Yep, that's what stood out to me as well. Let's focus on those while we conduct our physical exam. What else? [[Multiple-select question]]

''Attending Vet:'' We're not really seeing signs of aggression right now. //Wrong answer, try again:// [[Multiple-select question]]

''Attending Vet:'' I'm not sure about that. I didn't hear her mention anything about a physical injury, and she did say Abby was walking okay. [[Multiple-select question]]

''Attending Vet:'' Nope, she did mention that no vomiting was involved. [[Multiple-select question]]

''Attending Vet:'' Okay, we've got a lead. While we're examining Abby here, let's focus on these key elements. The popup window adds "symptoms" to a list of available files to browse. "General appearance" flashes to draw your attention. Proceed to [[general appearance.]]

''Attending Vet:'' That didn't stand out to me much. I'd be listening for issues with skin, fur, and lots of scratching if this were the case. [[Multiple-select question]]

''Attending Vet:'' Okay, just like before. What have you seen so far today? How is Abby behaving? [[Normal (bright, alert, and responsive)]] [[Depressed (quiet, alert, and sad).]] [[Obtunded (partially unresponsive, severely)]] [[Comatose (unconscious)]]

Correct! What about Abby's [[movement?]]

Are you sure? Does that best describe this dog's behavior? //Wrong answer, try again:// Go back to [[general appearance.]]

How is Abby's posture and gait? [[Normal.]] [[Abnormal (limping, unbalanced, etc).]]

''Attending Vet:'' Okay. She's slow, lethargic - we call that "depressed" on the form. These are some red flags that we can dive deeper into. Let's move to vitals. "Vital signs" flashes in the popup window. [[Go to vital signs.]]

''Attending Vet:'' Be careful not to confuse her gait with her general behavior. I think she's walking okay, but is just really fatigued otherwise. //Wrong answer, try again:// What is Abby's [[movement?]]

A window opens to record new information: ''Vital Signs'' Respiratory rate: Temperature: Heart rate / pulse: ''Attending Vet:'' First, let's measure her breath rate. Watch her chest expand and contract - here's a timer. Start [[timer.]]

You hear 10 breaths. How many breaths were there in 15 seconds? [[10 breaths]] [[20 breaths]]

''Attending Vet:'' Correct. What would be this dog's breath rate in minutes, then? Multiple choice question: [[breath rate]]?

''Attending Vet:'' Not quite. Remember, one breath includes both the expansion and contraction of the chest. Go back to [[timer.]]

Multiple choice question: What is this dog's breath rate, in minutes? [[10 breaths per minute]] [[20 breaths per minute]] [[30 breaths per minute]] [[40 breaths per minute]]

Nope. Remember to multiply the counted breaths by four. //Wrong answer, try again:// [[breath rate]].

''Attending Vet:'' Ten times four is 40 breaths per minute. That means really rapid, shallow breathing. We call this "tachypnea" - tachy meaning fast, and hypnea meaning breathing. Dr. Rodrigo steps over and gently restrains the dog. ''Attending Vet:'' Alright, how about her temperature? Here's the thermometer. <style> img { max-width: 100%; max-height: 100%; } </style> <img src=https://media.istockphoto.com/id/949472584/photo/model-shot-of-young-beagle-dog-with-flying-ears.jpg?s=612x612&w=0&k=20&c=T920Jy9joH9EzKQ0STAUrgDOFQSgW7syX3nAfG2ctIc=> </div> You are prompted to pick up the thermometer and place it to her ear. The thermometer processes for a second, then ''BEEPS''. [[Check the thermometer.]]

Not quite... Return to [[Check the thermometer.]]

''Attending Vet:'' Oh, that's definitely a fever. Poor thing! That might explain why she's so sluggish. Let's move onto the heart rate - here's your stethoscope. I'll set a timer... You count 32 beats in 15 seconds. ''Attending Vet:'' 32 beats in 15 seconds. Let's do [[the math]]...

The thermometer reads 103.2 F. //Question: Is 103.2°F body temperature in the normal range?// [[Too low (Hypothermia)]] [[Normal range]] [[Too high (Fever, pyrexia)]]

There were 32 heartbeats in 15 seconds. What is this dog's heart rate? [[32 bpm]] [[64 bpm]] [[128 bpm]]

Nope. Remember to multiply the counted heartbeats by four. //Wrong answer, try again:// [[go back|the math]].

Correct! Is 128 bpm in the normal range? [[Yes...]] [[No...]]

''Attending Vet:'' Okay, 32 times 4 is... 128 beats per minute. That seems good, at least. So to summarize, we're seeing tachypnea and a fever. The popup window lists new symptoms: "Rapid breathing (tachypnea)" and "Fever of 103.2°F". ''Attending Vet:'' Let's move onto the physical exam, keeping in mind the symptoms we've seen so far. "Physical Exam" flashes to catch your attention. [[Begin physical exam]]

Not quite... Normal range is 90 to 140 beats per minute. //Wrong answer, try again:// [[go back|128 bpm]]...

''Attending Vet:'' Check her gums - does she seem well-hydrated? You are prompted to place a hand to the dog's upper lip, lifting it up. The gums are exposed - they are tannish and do not shine in the light. ''Attending Vet:'' Her gums feel a bit sticky, don't they? [[What does this suggest?]]

How well-hydrated is Abby, based on appearance of gums? [[Normal hydration.]] [[Dehydrated.]]

Normal gums should be moist and pink. I think these look a bit different. [[go back|What does this suggest?]]

''Attending Vet:'' Dry, sticky gums, with an off color. Dry, sticky gums, with an off color. She is definitely dehydrated. "Dehydration" is added to the list of symptoms in your popup window. ''Attending Vet:'' Okay, what have we missed on this list so far? ... Ah, the respiratory system. Let's listen to her lungs. You are prompted to place the diaphragm to a sequence of locations on the dog's chest. In all locations, you hear ''crackling''. The right lung is ''quieter than usual''. The breathing is rapid and shallow. ''Attending Vet:'' Tell me [[what you hear]]

Do you hear anything unusual? [[Crackling (Rales).]] [[Wheezing.]] [[Left and right sounds are uneven.]] [[None of the above.]] [[You are done listening.]]

I haven't noticed anything like that so far. Focus more on [[what you hear]]

Correct! Focus more on [[what you hear]].

There's definitely something unusual here. Take another listen. Focus more on [[what you hear]]

Correct! Focus more on [[what you hear]].

''Attending Vet:'' Yeah, there's some wet crackling going on. And the right lung is kind of quiet - it's not working correctly. Something is wrong - neither of those are good signs. The symptoms panel is highlighted on the popup window, prompting you to open it. The window has a list categorized into a hierarchy. ''CLINICAL SIGNS / PROBLEM LIST'' Rapid breathing (tachypnea) Lung crackling Right lung quiet Fever of 103.2°F Sluggish, depressed behavior Loss of appetite Deyhydration ''Attending Vet:'' Okay, we've got a lot of different symptoms signaling some sort of illness or issue. We have a few clues from patient history and our physical, but [[nothing definitive]].

''Owner:'' So... what happens next? ''Attending Vet:'' It's time to start thinking of next steps - to start creating a diagnostic plan for Abby here. TO BE CONTINUED... You may close this window.

Are you sure? Does that best describe this dog's behavior? //Wrong answer, try again:// Go back to [[Behavior]].

''Pre-Vet Experience in 3D/VR (Act 1 of 3)'' ''Authors'' Primary author: Alex Vuong Advisement from Sarah Churgin and Jeff Kingsbury Produced by <a href="https://meteor.ame.asu.edu/" target="_blank">Meteor Studio</a> ''Date:'' March 1st, 2024 ''Copyright:'' (c) All rights reserved. This is an interactive script, viewable from a web browser. You may click on highlighted links to view the dialogue, answer questions, and gain a sense of the story's flow. Here is a [[highlighted link|Intro]].