Introduction
The physical examination is one of the jobs a veterinary technician does most often. You take the history, watch the patient, measure temperature, pulse and respiration (TPR), check the gums and hydration, listen to the chest and score body condition. The veterinarian uses your numbers to make decisions, so they must be accurate, recorded with units, and compared against the right species range.
The World Small Animal Veterinary Association (WSAVA) treats five assessments as vital signs in every small animal exam: temperature, pulse, respiration, pain and nutrition.9 This guide covers the first three in detail, plus nutrition through body and muscle condition scoring. Pain scoring has its own guide.
Key facts
- Merck reference ranges for rectal temperature: dog 37.5 to 39.2 °C (99.5 to 102.5 °F); cat 38.1 to 39.2 °C (100.5 to 102.5 °F).1
- Published dog and cat heart and respiratory rate ranges differ between references, and excitement and stress raise heart and respiratory rates (and a hot environment raises temperature) without disease.5
- Normal capillary refill time (CRT) is 1 to 2 seconds. Longer than 2 seconds suggests poor perfusion or vasoconstriction; under 1 second suggests a hyperdynamic state.4
- Pink mucous membranes are normal; pale or white suggests anemia or shock; cyanotic suggests severe hypoxemia; yellow suggests increased bilirubin.4
- A heartbeat with no matching pulse is a pulse deficit and usually means an arrhythmia.414
- On the 9-point body condition score (BCS), the goal for most pets is 4 to 5 of 9. Always record the denominator.9
- Muscle condition score (MCS) is graded normal, mild, moderate or severe loss, and an overweight pet can still have muscle loss.11
How the VTNE tests this
- Document and manage patient evaluations (Domain 5 Task B, which lists physical, behavioral, nutritional and mentation status; K28 "Animal assessment and monitoring techniques, excluding anesthetic monitoring").29 Expect "is this value normal for this species?"
- Interpret a finding: a CRT, a mucous membrane color, a pulse quality or a dehydration estimate, and pick the right next step.
- Locate: where to place the stethoscope for each valve area, where to feel a pulse in a dog or a horse, which lymph nodes are palpable.
- Calculate: a per-minute rate from a short count, a Celsius to Fahrenheit conversion, or a fluid deficit from a dehydration estimate (K13 covers fluid calculations).29
- Score: assign a 9-point BCS or an MCS from a description (K31 Nutrition).29
Core concepts
History and signalment come first
Signalment identifies the patient, including age, breed and sex.14 The history then develops the presenting complaint: onset, duration, frequency, progression, what makes it better or worse, and any medication given and the response. A body systems review asks about attitude, appetite, weight change, water intake and urination, vomiting, diarrhea, coughing and sneezing. The general overview covers environment, travel, vaccination, diet, parasite control, past medical history and current medications.22
Look before you touch
The distant (observational) exam happens as you greet the patient. Note alertness, body condition, posture, gait, behavior, hair coat and respiratory rate. A respiratory rate counted now is a true resting rate, taken before handling excites the animal.35
Mentation
Mentation is the level of consciousness. Four levels are used: alert (normal), depressed (decreased response, drowsy, inattentive), stuporous (responds only to a painful stimulus) and comatose (no response to any stimulus).23 Merck also uses "obtunded" for a patient that is less responsive and sleepy but still arousable.4 Record the term, not a guess at the cause.
Temperature: fever is not the only cause of a high reading
Hyperthermia means any body temperature above the normal range. Fever is one form of hyperthermia, where the hypothalamic set point has been raised. Heatstroke and exercise cause hyperthermia without fever.26 That is why the technician records the context of every high reading: was the dog just walked in from a hot car, or has it been lying quietly in a cage?
Pulse and perfusion
The pulse you feel is the pulse pressure: systolic minus diastolic pressure. In dogs and cats it is usually felt at the femoral artery; in horses, the facial artery. A weak pulse usually reflects low systolic pressure, as in heart failure or hypovolemic shock, but it can also come from poor technique or an obese or heavily muscled patient. A bounding pulse usually reflects a low diastolic pressure.14 Merck's triage table links a bounding pulse to the hyperdynamic (compensatory) stage of shock and a weak or absent pulse to decreased cardiac output or vasoconstriction.4
Perfusion is also judged from mucous membrane (MM) color and CRT. The CRT test is quick but not very sensitive, so a normal CRT does not prove normal perfusion.7
| Finding | What it suggests |
|---|---|
| Pink MM | Normal packed cell volume (PCV) and adequate perfusion |
| Pale or white MM | Anemia or shock |
| Cyanotic (blue) or muddy MM | Severe hypoxemia or decompensatory shock |
| Yellow (icteric) MM | Increased serum bilirubin from liver disease or hemolysis |
| Petechiae (pinpoint bleeds) | Possible low platelet count or platelet dysfunction |
| Dry or tacky MM | Dehydration, although panting and nausea also change moisture |
| CRT 1 to 2 seconds | Normal perfusion |
| CRT over 2 seconds | Poor perfusion or peripheral vasoconstriction |
| CRT under 1 second | Hyperdynamic state: fever, heatstroke, distributive shock or early compensatory shock |
Sources: Merck, Initial Triage and Resuscitation of Small Animal Emergency Patients4; Guelph Clinical Medicine 1, Head and Neck7; Merck, The Fluid Resuscitation Plan in Animals.8
In horses, Merck adds that gray membranes indicate poor tissue blood flow and red membranes can indicate shock.33
Hydration
Dehydration is a loss of fluid from the interstitial and intracellular spaces. It is estimated from physical findings, and the estimate is always partly subjective.8 Skin tenting is checked over the interscapular area: skin that does not spring straight back suggests dehydration, but the test is insensitive.24
| Estimate | Findings |
|---|---|
| 4 to 5% | Semidry oral MM, normal skin turgor, eyes normally moist |
| 6 to 7% | Dry oral MM, mild loss of skin turgor, eyes still moist |
| 8 to 10% | Dry MM, considerable loss of skin turgor, retracted eyes, acute weight loss, weak rapid pulses |
| 12% or more | Very dry MM, complete loss of skin turgor, severely retracted and dull eyes, possible altered consciousness, thready weak pulses |
Source: Merck, The Fluid Resuscitation Plan in Animals.8
These signs mislead in some patients. Emaciated and geriatric animals can have poor skin turgor and sunken eyes despite normal hydration. Very young animals have more elastic skin. Nauseated animals may drool, which keeps the gums moist.8
Body and muscle condition
BCS measures body fat. Scales of 5, 6, 7 or 9 points exist; WSAVA uses the 9-point scale, where most pets should be 4 to 5 of 9.9 On the 5-point scale, ideal is 3. Write the scale in the record, for example 4/9 or 4/5, so nobody confuses the two.13 You assess how easily the ribs are felt, the waist seen from above, the abdominal tuck seen from the side and the fat over the tail base.12 On the WSAVA dog chart, a 5 has ribs palpable without excess fat, a waist behind the ribs from above and a tucked abdomen from the side; a 7 has ribs palpable only with difficulty under heavy fat, fat over the lumbar area and tail base, and a waist that is absent or barely visible.10
MCS measures muscle, not fat. Feel over the spine, scapulae, skull and wings of the ilia. Muscle loss usually shows first in the epaxial muscles beside the spine. Grade it as normal, mild, moderate or severe loss, and score both BCS and MCS at every visit.11
Procedure: a nose-to-tail exam with TPR
- Prepare. Check the record for signalment, reason for visit and previous weights and vital signs. Have a stethoscope, watch with a second hand, thermometer, lubricant and gloves ready.
- Take the history from the client, following the structure above.22
- Observe from a distance: mentation, posture, gait and a resting respiratory rate.35
- Weigh the patient and record weight with units, BCS and MCS.9
- Head and neck. Look at eyes, ears and nose for discharge and symmetry. Open the mouth and check MM color and moisture, then press a fingertip on a pink, non-pigmented area of gum and count the CRT.7 Do not examine the mouth of an animal with neurological signs and an unknown rabies vaccination history.7
- Lymph nodes. Palpate the mandibular, superficial cervical (prescapular) and popliteal nodes for size, texture and pain. Normal nodes are soft and under 1 cm, often under 0.5 cm, in dogs and cats.36
- Heart. With the patient standing or sitting, in a quiet room, auscultate both sides of the chest (Figure 2). Count the rate. Hold the mouth closed if the dog is panting.6 Feel the femoral pulse at the same time; every heartbeat should have a pulse.17
- Lungs. Watch the breathing pattern first. Then listen in a grid of about 4 to 6 spots per side, and over the trachea to separate upper airway noise from lung sounds.17
- Skin, coat, abdomen and limbs. Run both hands over the whole body for masses, look for parasites and alopecia, and tent the skin over the shoulders.24
- Temperature. Insert a lubricated thermometer into the rectum and keep the tip in contact with the rectal wall.1831 In patients that resent it, such as ferrets, take it early, because struggling can raise the reading.30
- Record and report. Write each value with units, the method and the context. Use Figure 1 for anything outside the range.
Counting rates
A common shortcut is to count beats or breaths for 10 seconds and multiply by 6. One breath is one rise and fall of the chest.5 A short count multiplies any miscount by the same factor.
Auscultation
The diaphragm of the stethoscope picks up high-frequency sounds (most systolic murmurs, clicks and breath sounds); the bell picks up low-frequency sounds such as diastolic murmurs and gallops. Do not auscultate in lateral or dorsal recumbency, which can create false murmur-like sounds.6 The first heart sound (S1, closure of the AV valves) is loudest at the left apex, and the second (S2, closure of the semilunar valves) at the left base.16 Murmurs are graded 1 (very soft) to 6 (very loud, with a thrill, heard with the stethoscope just off the chest).16 Sinus arrhythmia is normal in dogs.14
Normal vital signs by species
| Species | Rectal temperature | Heart rate (bpm) | Respiratory rate (breaths/min) |
|---|---|---|---|
| Dog | 37.5 to 39.2 °C (99.5 to 102.5 °F) | 70 to 120 | 18 to 34 |
| Cat | 38.1 to 39.2 °C (100.5 to 102.5 °F) | 120 to 140 | 16 to 40 |
| Horse | Mare 37.3 to 38.2 °C (99.1 to 100.8 °F); stallion 37.2 to 38.1 °C (99.0 to 100.6 °F) | 28 to 40 | 10 to 14 |
| Dairy cow | 38.0 to 39.3 °C (100.4 to 102.8 °F) | 48 to 84 | 26 to 50 |
| Beef cow | 36.7 to 39.1 °C (98.0 to 102.4 °F) | Not listed (ox: 36 to 60) | Not listed |
| Sheep | 38.3 to 39.9 °C (100.9 to 103.8 °F) | 70 to 80 | 16 to 34 |
| Goat | 38.5 to 39.7 °C (101.3 to 103.5 °F) | 70 to 80 | About 25 to 30 in cool conditions (b) |
| Pig | 38.7 to 39.8 °C (101.6 to 103.6 °F) | 70 to 120 | 32 to 58 |
| Rabbit | 38.6 to 40.1 °C (101.5 to 104.2 °F) | 180 to 350 | 32 to 60 (c) |
| Ferret (a) | 100 to 103 °F (about 37.8 to 39.4 °C) | 200 to 250 | 30 to 40 |
| Guinea pig (a) | 38 to 39.5 °C (100.4 to 103.1 °F) | 200 to 350 | 40 to 100 |
| Chicken, adult | 40.6 to 43.0 °C (105.0 to 109.4 °F), daylight | 250 to 300 | Not listed; judge effort |
Sources: Merck reference guides for rectal temperature, resting heart rate and resting respiratory rate123; (a) Merck "Ferrets at a Glance" and "Physiological Data for Guinea Pigs"1920; (b) Constable and colleagues, at the lower end of the thermoneutral zone27; (c) Harcourt-Brown, Textbook of Rabbit Medicine.21 The ferret Celsius values are converted from Merck's Fahrenheit range.
Why dog and cat ranges disagree
Different references give different numbers, and context changes all of them.5 The Merck reference guides are adapted from a physiology textbook (Dukes' Physiology of Domestic Animals, 2004), while the Merck triage table and the Guelph text are written for patients being examined in the clinic.24 Learn the pattern, and use your hospital's chosen reference consistently.
| Measure | Merck reference guides | Merck triage table | Guelph Clinical Medicine 1 |
|---|---|---|---|
| Dog heart rate (bpm) | 70 to 120 | 70 to 120 (small dogs); 60 to 120 (large dogs); tachycardia above 180 | 60 to 160 |
| Cat heart rate (bpm) | 120 to 140 | 150 to 220; tachycardia above 220 | 120 to 240 |
| Dog respiratory rate | 18 to 34 | Not given | 10 to 30 |
| Cat respiratory rate | 16 to 40 | Not given | 24 to 42 |
| Dog temperature | 37.5 to 39.2 °C | Not given | 38.0 to 39.4 °C |
| Cat temperature | 38.1 to 39.2 °C | Not given | 38.0 to 39.2 °C |
Sources: Merck reference guides123; Merck triage4; Guelph, Vital Parameters and Hydration Assessment.5
Flowchart: an abnormal TPR
An abnormal reading is a prompt to act, not a diagnosis. Merck lists problems that warrant moving the patient to the treatment area for immediate veterinary evaluation regardless of the rest of the exam, including collapse, respiratory difficulty, paleness and weakness, seizures, heatstroke, hypothermia and a male cat that cannot urinate.4 For everything else, the first job is to rule out a measurement or context problem. The Emergency Triage study guide carries on from the red-flag branch.
Species differences
- Dog: small dogs have faster heart rates than large dogs.374 Sinus arrhythmia is normal.14
- Cat: breath sounds can be very quiet or hard to hear in a normal cat.17 The dog valve areas are less useful; murmurs are usually loudest along or just off the sternum, and about 20 to 25% of feline murmurs are not linked to significant disease.16 If a rectal temperature is not possible, axillary temperature is preferred over the ear, but neither can be used interchangeably with rectal.31
- Horse: feel the pulse at the facial artery. Second-degree AV block can be a normal finding.14 BCS also runs 1 to 9; 5 is moderate, and 7 or more is considered obese.34
- Cattle: count the respiratory rate from outside the pen, watching the flank for at least 15 seconds, before you disturb the cow. Check MM color and CRT (under 2 seconds) on the vulvar membranes. Auscultate the rumen in the left paralumbar fossa: 1 to 2 contractions per minute is the reference range for adult cattle. The same Guelph protocol gives 10 to 30 breaths/min and 38.0 to 39.0 °C for adult cattle, lower than the Merck dairy cow figures in Table 3, so know which reference your hospital uses.18
- Sheep and goats: in adult ruminants, a respiratory rate above 40 breaths per minute is panting, and it is the most practical sign of heat stress.27
- Rabbit: rabbits breathe through the nose and do not mouth-breathe or pant effectively. A faster rate can reflect stress, pain, hyperthermia, infection or respiratory disease.21
- Ferret: heart rate is rapid, often with a pronounced sinus arrhythmia, and subtle murmurs may be missed when the ferret is excited.30
- Backyard poultry: a healthy bird is bright and alert, with no tail bobbing (a sign of increased respiratory effort). Give emergency care before the exam for bleeding, head trauma, seizures, open fractures, extreme respiratory difficulty or weakness. Assess body condition by feeling the breast muscles on each side of the keel bone.28
Calculation
1. Heart rate from a 10-second count. You count 21 beats in 10 seconds.
21 beats / 10 s × 60 s / 1 min = 21 × 6 = 126 beats/min.5
2. Celsius to Fahrenheit. A dog reads 39.5 °C. Use °F = (°C × 9/5) + 32.25
(39.5 × 9/5) + 32 = 71.1 + 32 = 103.1 °F, above the Merck dog range of 99.5 to 102.5 °F.1
3. Fluid deficit from a dehydration estimate. A 12 kg dog is estimated to be 8% dehydrated. Multiply body weight in kilograms by the percentage as a decimal.8
12 kg × 0.08 = 0.96 kg of water lost, which is 0.96 L (960 mL), since 1 kg of water is about 1 L.
Safety, legal and client education
- Rabies risk. Do not open the mouth of an animal with neurological signs and an unknown rabies vaccination history.7
- Record keeping. Record every value with units and method (rectal, axillary), the BCS with its denominator, and the context (panting, just walked in, struggling). The next person needs to compare like with like.13
- Large animal safety. Take the respiratory rate and general inspection from outside the pen first, and consider restraint and facilities before you enter.18
- Client education: body condition. A BCS of 4 to 5 of 9 may look too thin to some owners, so explain the score with the chart and let the owner feel the ribs.9
Common mistakes and exam traps
- Calling a stressed cat tachycardic. A cat at 200 bpm in the exam room is below Merck's triage cut-off of 220 for tachycardia. Record it with the context.4
- Reading a fast CRT as good news. Under 1 second suggests a hyperdynamic state, such as fever or early shock.4
- Mixing up BCS scales. 3/5 and 5/9 both mean ideal. A score written without its denominator is useless.13
- Assuming a normal BCS rules out wasting. Muscle loss can be present in an overweight pet.11
- Trusting skin tent alone. Old, thin and very young patients give misleading results.8
- Feeling for a femoral pulse in a horse. In dogs and cats the pulse is usually taken at the femoral artery; in horses, the facial artery is usually used.14
Quick review
- WSAVA vital assessments: temperature, pulse, respiration, pain and nutrition.
- Signalment (age, breed, sex) first; then the presenting complaint and history.
- Count the resting respiratory rate before you handle the patient.
- Dog 37.5 to 39.2 °C; cat 38.1 to 39.2 °C (Merck).
- Horse heart rate 28 to 40 bpm and respiratory rate 10 to 14 (Merck).
- CRT normal 1 to 2 seconds; over 2 is poor perfusion, under 1 is hyperdynamic.
- Pale means anemia or shock; blue means hypoxemia; yellow means bilirubin.
- Every heartbeat should have a femoral pulse; a missing pulse is a pulse deficit.
- Dog valves: P, A, M on the left (2nd to 4th, 4th, 5th ICS); T on the right (3rd to 5th ICS).
- Dehydration 6 to 7%: dry gums and mild loss of turgor; 8 to 10% adds sunken eyes and weak pulses.
- Ideal BCS is 4 to 5 of 9; record the scale and score MCS too.
- Fluid deficit (L) = body weight (kg) × dehydration as a decimal.