Unit 1 Approach to the Emergency PatientTriage and cadiopulmonary resuscitationShock, vascular access and fluid therapyEmergency diagnosticsOutcome 1:Outcome 2:Outcome 3:Unit 2 Supporting the Critical PatientMonitoring the critical patientCritical care nursingAnaesthesia and analgesiaOutcome 1:Outcome 2:Outcome 3:Unit 3 Emergency Medicine 1Cardiovascular emergenciesRespiratory emergenciesHaematological and haemostatic emergenciesOutcome 1:Outcome 2:Outcome 3:Unit 4 Emergency Medicine 2Gastrointestinal emergenciesEndocrine emergenciesUrogenital emergenciesOutcome 1:Outcome 2:Outcome 3:Unit 5 Emergency Medicine 3Neurological and ophthalmic emergenciesSmall mammal, bird and reptile emergenciesIntoxicationsOutcome 1:Outcome 2:Outcome 3:Unit 6 Surgical EmergenciesOrthopaedic and soft tissue injuriesENT and thoracic surgical emergenciesAbdominal surgical emergenciesOutcome 1:Outcome 2:Outcome 3:www.vets-now.com/certvnecc
Unit 2Supporting the Critical Patient 2.1 Monitoring the critical patient2.2 Critical care nursing2.3 Anaesthesia and analgesia Concentrating on essential nursingskills to support the critical patient thisunit will reflect on; patient monitoringand management of thecardiovascular, respiratory andneurological systems using ECG,Doppler, capnography, pulse oximetry,blood pressure and laboratoryparameters.Critical care nursing will discuss theprinciples of nutritional support, including assisted feeding methods,recognition, prevention and care ofnosocomial infections and the principlesand techniques of physiotherapy. The importance of anaesthetic monitoringand maintenance in an emergency isreviewed in outcome three.
Unit 3Emergency Medicine 13.1 Cardiovascular emergencies3.2 Respiratory emergencies 3.3 Haematological and haemostatic emergenciesDealing with cardiac and vascular emergencies, this unit considers the clinical signsand management of: heart failure, cardiac tamponade including pericardiocentesis,pericardial effusion, saddle thrombus and systemic and pulmonary hypertension.Recognition of ECG traces for the different types of cardiac arrhythmias and thetherapy needed to manage them, will also be considered.Respiratory emergencies focuses onrecognising and providing immediatefirst aid as well as more in-depthmanagement of pleural effusions,pneumothorax, diaphragmatichernia/rupture and flail chest.Guidance on placing nasaloxygen catheters, how toperform a tracheostomy, theindications for thoracocentesisand thoracostomy tubeplacement and techniques arealso detailed.The final outcome exploreshaematological and haemostaticemergencies including bloodtransfusion of cats and dogs.www.vets-now.com/certvnecc
Unit 4Emergency Medicine 24.1 Gastro-intestinal (GIT) emergencies4.2 Endocrine emergencies4.3 Urogenital emergencies Dealing with emergencies, their diagnosisand management, this unit concentrateson gastro-intestinal emergencies such asvomiting, diarrhoea, pancreatitis andcanine parvovirus enteritis.Endocrine emergencies includingAddisonian crisis, ketoacidosis,hypoglycaemia, hyperglycaemia andcalcium disturbances will be considered.Likewise the aetiology, pathogenesisand pathophysiology of urogenitalemergencies, such as acute and chronicrenal failure, urethral obstructions in catsand dogs, urinary bladder rupture,dystocia, pyometra, eclampsia andparaphimosis will also be explored.Treatment, complications, monitoringand nursing care of these cases aresimilarly vital.www.vets-now.com/certvnecc
Unit 5Emergency Medicine 35.1 Neurological and ophthalmic emergencies5.2 Small mammal, bird and reptile emergencies 5.3 IntoxicationsA broad unit spanning emergencyproblems associated with the nervoussystem and eyes, exotic species andtoxicology of dogs and cats.Neurological and ophthalmic emergenciesfocuses on management of seizuringpatients, the degree of spinal and braininjuries and the clinical signs, diagnosticsand assessment of ophthalmicemergencies including cornealulceration, exophthalmos/glaucoma andproptosis of the globe.
Small mammal, bird and reptileemergencies, examines significantdifferences regarding anatomy, nutritionand husbandry of small mammals, birdsand reptiles. Safe examination andassessment techniques are alsoconsidered, along with anaesthesia andanalgesia, assisted feeding and fluidchoices.
The final outcome concentrates onintoxications, the importance ofmanaging the initial phone call, thegeneral principles behind poison therapyand the clinical signs and managementof different types of intoxication.www.vets-now.com/certvnecc
Unit 6Surgical Emergencies6.1 Orthopaedic and soft tissue injuries 6.2 ENT and thoracic surgical emergencies6.3 Abdominal surgical emergencies Dealing with surgical emergencies,primarily the emergency and surgicalmanagement of wounds, ear, nose andthroat, chest and abdominal injuries. Thisunit reviews emergency surgicalmanagement of wounds and fractures,including appropriate cleaningtechniques, products and dressings. ENT and thoracic surgicalemergencies apprises the diagnosticsand management of ear nose andthroat and thoracic injuries; includingnasopharyngeal, laryngeal andtracheal injuries. Creation andplacement of a tracheostomy isdescribed alongside the indications,procedure and post-operativemanagement of thoracotomy andchest drains.Abdominal surgical emergenciesconsiders the treatment, monitoring andnursing care of patients with gastricdilatation and/or volvulus, foreign bodies,intussusception, peritonitis, dystocia,ruptured uterus and uterine torsion.
Take the plunge into emergency and critical care,by building on your existing skills and knowledgeto enhance patient care in ECC cases.Progression through the course is demonstrated by submission of unitcoursework assignments. Forming key preparation for the final assessments,your submissions will allow your tutor to fully assess your knowledge andunderstanding whilst also providing guidance and feedback.You will develop key transferable studyskills, including research andreferencing; evidence of which shouldbe included in your assignments.You should expect to spend atleast 10 – 15 hours per week oncoursework, research andreading.You might find you spend more or lesstime than this some weeks. But the moreyou put in the more you will get out of it.Good time management skills and a lotof motivation are essential to completethe course.Final award of the Certificate isdependent on successful completion ofthe final assessment papers.Want to know more?To give you an idea of what to expect from the coursework, we have included twosample assignment questions overleaf. Have a go at answering these and see howyou get on. You’ll also find a small excerpt of some of the unit course notes.Please note: These are sample questions and do not form part of any current course content.
Unit 1.1Open Learning AssignmentPlease complete the following assignment and upload it formarking by your tutor.Advised word count (excluding questions, assignment instructions,reference and bibliography list) ~ 1500 - 3000 words. Please do notexceed 4500 words.Explain what your first action should beb. Describe how this should be performed.c. List the equipment and drugs that should be on anemergency trolley for such an emergency and a reason whyeach item may be required.Your colleague is performing cardiac compressions inaccordance with the RECOVER guidelines. You are asked toperform IPPV.1. You are monitoring a cat undergoing surgery to remove anintestinal foreign body. During the surgery the cat stopsbreathing and a pulse cannot be detected.a.www.vets-now.com/certvnecc
Unit 4.1Open Learning AssignmentPlease complete the following assignment and upload it formarking by your tutor.Advised word count (excluding questions, assignmentinstructions, reference and bibliography list) ~ 1500 - 3000words. Please do not exceed 4500 words.a. Abdominocentesis is to be performed. Discuss how fluid obtained from DPL could be analysedb. No fluid has been found on abdominocentesis, so diagnostic peritoneal lavage (DPL) is now going to be performed.1. A dog, Timmy, is presented with a suspected peritonealeffusion.Explain what DPL is and under what circumstances it might beperformedDiscuss how the patient should be prepared for this procedure.Discuss any additional equipment that should be prepared.Describe the procedure for DPLi.ii.iii.iv.c.i. Describe how Timmy should be prepared for the procedure ii. Discuss the preparation of and equipment required for carrying out abdominocentesis.www.vets-now.com/certvnecc
Supporting the Emergency & Critical Care Patient Course Notes Excerpt: Unit 2 Outcome 1: Monitoring the Critical Patient 2.1.2.2 Electrocardiography (ECG)ECG is readily available and technicallyeasy to perform (WikiVet, 2012)Metal alligator clips can be used fortemporary monitoring.Adhesive patches can be attached forlonger-term use. They are morecomfortable for the patient. Alcohol or a conducting gel placedbetween the patient’s skin and metalclips will improve conduction. To avoidthe risk of fire, alcohol should not beapplied to the patient if there is anyimminent possibility of electricaldefibrillation e.g. a patient with CPA. Veterinary nurses should be able torecognise normal and abnormalrhythms especially the more seriousabnormal rhythms.ECG uses the electrical impulsesgenerated by the cardiac conductionsystem to create a tracing which can beused for monitoring both the heart rateand rhythm. It does not, however, giveany indication of heart function i.e. theability of the myocardium to contract norif the patient is in heart failure. The ECGmonitors and transmits electrical activityat the body surface to create the ECGtrace. Common ECG disturbances, in critically illpatients, include sinus tachycardia, sinusbradycardia, accelerated idioventricular(pertaining to the cardiac ventricle alone)rhythm, premature ventricularcomplexes and ventricular tachycardia.ECG manifestations of hyperkalaemia(spiked T waves, prolonged PR interval,loss of P waves and widening of the QRS)may occur in patients with urinary tractdysfunction resulting in decreased urineoutput e.g. bladder rupture or urethralobstruction. Hyperkalaemia can cause afatal cardiac arrythmia so promptrecognition of ECG changes suggestive ofit are crucial. The need to treat and choice oftreatment for cardiac dysrhythmias isdependent on various factors- heart rate,clinical signs, evidence of perfusionabnormalities, underlying cause andpresence of specific ECG changes e.g.multiform complexes or the ‘R on T’phenomenon.
Dysrhythmias considered secondary tohypovolaemia, hypoxaemia, or excessivecatecholamines are usually managedinitially by treating the underlying causee.g. improving haemodynamic status of adog with gastric dilation and volvulus(GDV). Often by doing so the dysrhythmiawill resolve.It is likely that a dog has an acceleratedidioventricular rhythm if there are four ormore consecutive ventricular ectopicbeats/ ventricular premature contraction(VPCs) but the heart rate is ≤ ~ 140 beatsper minute. In the absence of perfusionabnormalities attributed to this rhythm,definitive treatment with anantidysrhythmic is not warranted as thetreatment may lead to serious side-effects. Maintenance of euvolaemia(normal blood volume), adequateoxygenation, and normal acid-base andelectrolyte status is indicated. Dysrhythmias resulting in decreasedperfusion, as evidenced by clinical signs(e.g. depression, syncope, poor pulsequality, pale mucous membranes, coolextremities, prolonged CRT) or objectivemeans (hypotension, hyperlactataemia)will required additional treatmentfollowing correction of hypovolaemia andhypoxaemia.Ko and Krimmins (2012) describe how toperform an ECG examination.Stepiens (2005) discusses abnormal ECGrhythms that might arise in ECC patients, when and how to treat.Course notes excerpt: Unit 2 Outcome 1: Monitoring the Critical Patient (May 2020)
Emergency Medicine 1Course Notes Excerpt: Unit 3 Outcome 1: Cardiovascular Emergencies3.1.1 Introduction’Dysfunction of the cardiovascular systemis a common cause of veterinaryemergency presentations. This outcomewill cover primary heart conditions (e.g.dilated cardiomyopathy); and those thatoccur secondary to cardiovasculardisease (e.g. congestive heart failure). N.B.Some use the term respiratory difficultyinstead of dyspnoea in relation toanimals with breathing difficulties.Dyspnoea is something an individual feel.As animals cannot tell us what they feel,respiratory difficulty is possibly a moreaccurate description. However, as theterms dyspnoea and dyspnoeic are stillwidely used in the veterinary professionthey are used in these course notesmeantime.3.1.2 TerminologySome of the terminology that will beused in this outcome is listed below.Make sure you are aware of the meaningand can explain each of the followingterms: HypertensionHypotensionArrhythmiaTachycardiaBradycardiaPerfusionPreload and afterloadForward and backward failureInotropeChronotropeCachexiaTamponade3.1.3 Physiology of theCardiovascular SystemThe function of the cardiovascularsystem is to deliver oxygen, nutrientsand hormones etc. to all tissues; removewaste products; perform a regulatoryrole and protect against infection.Copyright © 2013 Vets Now Ltd. All rights reserved
maintenance of normal systemic andpulmonary arterial blood pressure. maintenance of normal tissueperfusion maintenance of normal systemic andpulmonary venous pressuresTo perform these roles, thecardiovascular system must performthree basic functions: 1.2.3.Course notes excerpt: Unit 3 Outcome 1: Cardiovascular Emergencies (July 20V)3.1.3.1 Cardiac outputCardiac output is the volume of bloodthat is pumped from the heart eachminute. It is the product of the heart rate(HR) and stroke volume (SV). SV is thevolume of blood that is pumped by theheart with each beat. Cardiac Output = HR x SVThe stroke volume is determined by threemain factors: a. the preload (how much blood is withinthe ventricles prior to the heart pumping:i.e. the end-diastolic volume)b. the afterload (i.e. back pressure causedby resistance within blood vessels andorgans that restricts the volume of bloodable to leave the heart)CardiacoutputHeart RateStrokeVolumePreloadContractilityAfterloadFrom this it is apparent that the heartwill fail to circulate sufficient bloodaround the body if any one or more ofthese factors is significantly altered. Decreased cardiac output leads todecreased tissue perfusion and oxygendelivery with potentially very seriousconsequences.c. the contractility of the heart itself i.e.the heart’s innate strength and elasticityproducing the contraction.Copyright © 2013 Vets Now Ltd. All rights reserved
Emergency Medicine 3Course Notes Excerpt: Unit 5 Outcome 3: Toxicological Emergencies(Intoxications)Please note the information in these course notes is for GUIDANCE ONLY. A veterinary surgeonand a current, toxicology specific resource should always be consulted about the managementof any potential or actual poisoning case. 5.3.1 IntroductionThis outcome will cover the poisons andtoxins that are the most common cause ofpotential or actual illness in cats and dogs.This document does not cover allpoisonings and it is important to be awarethat there is an increasing range of causesof poisoning in veterinary practice. The reader is probably already aware of theVeterinary Poisons Information Service(VPIS) (http://vpisglobal.com/), whichveterinary practices can subscribe to. VPIS provide a 24-hour service allowingclinicians and veterinary nurses to find outwhether a product is poisonous/toxic; whatthe poisonous/toxic dose is; clinical signs ofpoisoning/toxicity; availability and dose ofantidote; recommended management ofthe poisoning/toxicity and prognosis. It isimportant that owners are made aware ofthe cost of this service if it is required. It is auseful resource for studying for thisoutcome. Concerned owners can now also access‘The Animal Poison Line’ for advicehttps://www.animalpoisonline.co.uk/ The VPIS has teamed up with Vets Nowto provide the ToxBox 24-Hour Service.This can provide veterinary practiceswith 24-hour access to drugs andproducts which may be needed for theemergency management of a poisoning(http://vpisglobal.com/toxbox/). BSAVA members can also access theBSAVA/VPIS Poisons Triage Tool.5.3.2 TerminologyThe terminology can be a bit confusingwith some terms being usedinterchangeably. The correct definitions are providedbelow.Copyright © 2013 Vets Now Ltd. All rights reserved
Toxicity: The ability of a poison/ toxin tocause toxicosisToxicosis: The disease state caused bysomething poisonous/ toxicToxic: Poisonous substancePoison: A substance which can causeharm to a living organismToxin: A poisonous substance producedby a living organismIntoxication: The condition that arisesdue to ingestion of a chemicalsubstance which results in alteredconsciousness, cognition or behavioure.g. alcohol. (In)toxicant: A substance which causestoxicosis or intoxication e.g. cleaningproduct or alcoholVenom: A toxin (produced by a livingorganism) which is injected from aliving organism into another e.g. anAdder biting a dogAntitoxin: A substance (antibody),produced by a living organism thatcounteracts/ neutralises a specific toxine.g. tetanus antitoxinAntivenom: A substance (antibody),produced by a living organism thatcounteracts/ neutralises a specificvenom e.g. adder antiserumAntidote: A substance whichcounteracts a specific poisonCourse notes excerpt: Unit 5 Outcome 3:: Toxicological Emergencies (Intoxications) Jun 20VCathartic: A substance which causesemptying of the GI tract = laxative.Gavage/ gastric lavage: Introducingmaterial into the stomach via astomach tube; washing out thestomach using a liquid.Adsorption: The adhesion of asubstance to another surface.Adsorbent: A substance that causesadsorption of another. In a poisoningcase the action of an adsorbent (e.g.active charcoal) limits absorption of apoison into the body.The availability of many toxic productsin and around the home/ garage e.g.cleaning products, owner medication,car products e.g. antifreezeThe naturally inquisitive nature of catsand dogs(Babyak and Lee, 2018)Exposure to substances that can causetoxicosis in cats and dogs occurs relativelyfrequently for several reasons: (Babyak and Lee, 2018)There are several stages involved in themanagement of the poisoned patient.The order in which some of these areperformed will depend on the nature ofpoisoning and the patient’s condition on
telephone triageprimary triage assessmentfull clinical examination and historytakingstabilisation +/- decontaminationfurther treatmentpresentation e.g. emergency stabilisationmay be required prior to a full historybeing obtained from the owner.Approach to a poisoned patient:(Lee, 2013)Course notes excerpt: Unit 5 Outcome 3:: Toxicological Emergencies (Intoxications) Jun 20V5.3.3 Telephone History Takingand Advice‘Nurses are frequently the first membersof staff with which owners ringing aboutsuspected or witnessed poisoning willcommunicate. It is therefore imperativethat all nurses are well rehearsed in thequestions that are important to ask andadvice should be sought from theveterinary surgeon if there is any concern’(Jasani, 2017).It is important to be aware of the mode ofaction of the more common toxicsubstances that animals can be exposed;and those toxic substances where there isa narrow margin of safety i.e. ingestion ofa small amount can result in toxicity e.g.baclofen.www.vets-now.com/certvneccCopyright © 2013 Vets Now Ltd.All rights reserved
If you have an interest in emergency & critical care, then the Cert VNECC could be your unique opportunity to build on your existing skillsand knowledge to achieve a Level 4, industry recognised, City &Guilds qualification in small animal emergency and critical carenursing.Affordable and flexible, withtutor supported online content;the Cert VN ECC offers accessible,inclusive learning wherever you are.April & OctoberAnnual intakes inApply now atwww.vets-now.com/certvnecc