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Unlock your potential in ECC with the Certificate ofVeterinary Nursing in Emergency & Critical Care. Annual intakes inApply now at April & Octoberwww.vets-now.com/certvneccOne unit is released every 9 weeks supplying students with a full set of coursenotes, self-assessment questions, unit forum and webinars. You will also receivefree access to a huge library of additional resources and recorded webinars tosupport your learning.Delivered online, over 18 months, with tutor supported learning; the Cert VN ECCis accessible whenever and whereever you are. Exploring the fundamentals ofECC, the theory based course content is delivered across 6 core units, which aresplit into learning outcomes and supported by corresponding courseworkassignments. An accredited qualification, providing a Level 4 industry recognisedqualification, the Cert VN ECC allows you to build on your existing nursing skillsto develop your interest in ECC.

Unit 5 Emergency Medicine 3Neurological & Ophthalmic emergencies Small mammal, bird and reptile emergencies IntoxicationsGastrointestinal emergenciesEndocrine emergenciesUrogenital emergenciesUnit 4 Emergency Medicine 2Cardiovascular emergenciesRespiratory emergenciesHaematological and haemostatic emergenciesUnit 3 Emergency Medicine 1Unit 1 Approach to the Emergency PatientTriage and cadiopulmonary resuscitation Shock,vascular access and fluid therapy EmergencydiagnosticsUnit 2 Supporting the Critical PatientMonitoring the critical patient Nursing the critical patient Anaesthesia & AnalgesiaUnit 6 Surgical EmergenciesOrthopaedic and soft tissue injuries ENT and thoracic surgical emergenciesAbdominal surgical emergencieswww.vets-now.com/certvnecc

Examining ECGs andMinimum Database, theEmergency diagnosticsoutcome, will also reviewradiography and ultrasoundimaging modalities; exploringthe significant findings,rationale and means ofimaging the thorax, abdomenand skeletal system usingthese modalities. Laboratory diagnostics in theemergency patient will also bereviewed.Focussing on recognition of clinical warning signs in the small animal patient,this unit considers the response to a life-threatening event, as well as nursingsupport of the patient after stabilisation. The planning of care and initialmanagement of the patient in shock will be explored, including vascularaccess routes and fluid administration (crystalloids and colloids).www.vets-now.com/certvneccTriage and cardiopulmonary resuscitationShock, vascular access and fluid therapyEmergency diagnosticsApproach to the Emergency PatientApproach to the Emergency PatientUnit 1Unit 1

Critical care nursing will discuss theprinciples of nutritional support,including assisted feedingmethods;recognition, prevention and care ofnosocomial infections and theprinciples and techniques ofphysiotherapy. The importance of anaesthesia andanalgesia in an emergency is alsoreviewed.Concentrating on essential nursingskills to support the critical patientthis unit reflects on; patientmonitoring and management of thecardiovascular, respiratory andneurological systems using ECG,Doppler, capnography, pulseoximetry, blood pressure andlaboratory parameters.Supporting the Critical Patient Unit 2Monitoring the critical patientCritical care nursingAnaesthesia & Analgesia

Cardiovascular emergenciesRespiratory emergenciesHaematological and haemostatic emergenciesRespiratory emergencies focuses onrecognising and providing immediate first aid,as well as more in-depth management ofpleural effusions, pneumothorax, diaphragmatichernia/ rupture and flail chest.www.vets-now.com/certvneccUnit 3Emergency Medicine 1Placing nasal oxygen catheters and how toperform a tracheostomy will be reviewed aswell as indications for thoracocentesis andthoracostomy tube placement andtechniques.The final outcome explores haematologicaland haemostatic emergencies; reviewing thedifferent types of anaemias, appropriatediagnostics and treatments and bloodtransfusion of cats and dogs.Dealing with cardiac and vascular emergencies, this unit considers the clinicalsigns and management of heart failure, cardiac tamponade includingpericardiocentesis, pericardial effusion, saddle thrombus and systemic andpulmonary hypertension. Recognition of ECG traces for the different types ofcardiac arrhythmias and the therapy needed to manage them, will also bereviewed.

Gastro-intestinal (GIT) emergenciesEndocrine emergenciesUrogenital emergenciesFurther outcomes will explore theaetiology, pathogenesis andpathophysiology of urogenitalemergencies, such as acute andchronic renal failure, urethralobstructions in cats and dogs, urinarybladder rupture, dystocia, pyometra,eclampsia and paraphimosis.Treatment, complications, monitoringand nursing care of these cases arevital and will be reviewed in detail.Dealing with abdominal disorders inthe emergency and critical carepatient, this outcome concentrateson gastro-intestinal emergenciessuch as vomiting, diarrhoea,pancreatitis and canine parvovirusenteritis.Focusing on the principles ofEndocrine disorders, this outcomewill review Addisonian crisis’,ketoacidosis, hypoglycaemia andhyperglycaemia as well asconsidering calcium disturbances.Emergency Medicine 2Unit 4www.vets-now.com/certvnecc

Neurological emergencies reviewsmanagement of seizuring patients,the degree of spinal and braininjuries. Small mammal, bird and reptileemergencies, examines significantdifferences regarding anatomy,nutrition and husbandry of smallmammals, birds and reptiles. Safeexamination and assessmenttechniques are also considered, alongwith anaesthesia and analgesia,assisted feeding and fluid choices. The final outcome concentrates onintoxications, the importance ofmanaging the initial phone call, thegeneral principles behind poisontherapy and the clinical signs andmanagement of different types ofintoxication.A broad unit spanning emergencyproblems associated with thenervous system and eyes, exoticspecies and toxicology of dogs andcats.Ophthalmic emergencies focuses onthe clinical signs, diagnostics andassessment of ophthalmicemergencies, including cornealulceration, exophthalmos/glaucomaand proptosis of the globe. Unit 5Emergency Medicine 3www.vets-now.com/certvneccNeurolgical and ophthalmic emergenciesSmall mammal, bird and reptile emergenciesIntoxications

Orthopaedic and soft tissue emergenciesENT and thoracic surgical emergenciesAbdominal surgical emergenciesDealing with surgical emergencies,primarily the emergency and surgicalmanagement of wounds, ear, noseand throat, chest and abdominalinjuries. This unit reviews emergencysurgical management of wounds andfractures, including appropriatecleaning techniques, products anddressings. ENT and thoracic surgicalemergencies apprises the diagnosticsand management of ear nose andthroat and thoracic injuries; includingnasopharyngeal, laryngeal and tracheal injuries. Creation andplacement of a tracheostomy isdescribed alongside the indications,procedure and post-operativemanagement of thoracotomy andchest drains.Abdominal surgical emergenciesconsiders the treatment, monitoringand nursing care of patients withgastric dilatation and/or volvulus,foreign bodies, intussusception,peritonitis, dystocia, ruptured uterusand uterine torsion. Surgical EmergenciesUnit 6

Final award of the Certificate is dependent on successful completion of allcoursework components and the final assessment papers. To give you an idea of what to expect from the coursework, we have includedtwo sample written assignment questions overleaf. You’ll also find a smallexcerpt of some of the unit course notes after that. Please note: These are sample questions and do not form part of any current course content. Take the plunge into emergency and critical care,by building on your existing skills and knowledgeto enhance patient care in ECC cases.Want to know more?You should expect to spend at least 10 – 20 hours per week on coursework,research and reading. You will develop key transferable studyskills, including research and referencing;evidence of which should be included inyour written assignments. You might find you spend more or lesstime than this some weeks.But the more you put in, the moreyou will get out of it.Good time management skills and a lotof motivation are essential to completethe course.Progression through the course is demonstrated by completionof a variety of summative coursework assignments,which contribute towards your final grade and form key preparation for the final assessments. Completion of the coursework will allow your tutor to fullyassess your knowledge and understanding whilst also providing you guidance andfeedback.

Assignments should be typed and uploaded to Moodle tobe graded by your tutor.b. 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 in accordance withthe RECOVER guidelines. You are asked to perform IPPV.1. You are monitoring a cat undergoing surgery to remove an intestinalforeign body. During the surgery the cat stops breathing and a pulsecannot be detected. Explain what your first action should be.a.Sample OpenLearning Assignmentwww.vets-now.com/certvnecc~ 1500 - 3000 words. Please do not exceed 4500 words.Note: excluding questions, assignment instructions, reference andbibliography list)Advised word count

a. Abdominocentesis is to be performed.b. 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 peritoneal effusion. Discuss how fluid obtained from DPL could be analysedc.i. Explain what DPL is and under what circumstances it might beperformed ii. Discuss how the patient should be prepared for this procedure.iii. Discuss any additional equipment that should be prepared. iv. Describe the procedure for DPLwww.vets-now.com/certvnecci. Describe how Timmy should be prepared for the procedure ii. Discuss the preparation of and equipment required for carrying outabdominocentesis.Sample OpenLearning AssignmentAssignments should be typed and uploaded to Moodle to begraded by your tutor.~ 1500 - 3000 words. Please do not exceed 4500 words.Note: excluding questions, assignment instructions, reference andbibliography list)Advised word countSample OpenLearning Assignment

Copyright © 2013 Vets Now Ltd. All rights reservedCourse notes excerpt: Unit 2 Outcome 1: Monitoring the Critical Patient (May 2020)Unit 2 Outcome 1: Monitoring the Critical Patient 2.1.2.2 Electrocardiography (ECG)ECG uses the electrical impulses generatedby the cardiac conduction system to createa tracing which can be used for monitoringboth the heart rate and rhythm. It does not,however, give any indication of heartfunction i.e. the ability of the myocardiumto contract nor if the patient is in heartfailure. The ECG monitors and transmits electricalactivity at the body surface to create theECG trace. ECG is readily available and technicallyeasy to perform. WikiVet (2023) explainthe basics of ECG.Metal alligator clips can be used fortemporary monitoring.Adhesive patches can be attached forlonger-term use as 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. Supporting the Emergency & Critical Care Patient Veterinary nurses should be able torecognise normal and abnormalrhythms, especially the more seriousabnormal rhythms (Stepien, 2008).Common ECG rhythm disturbances(arrythmias/ dysrhythmias), in critically illpatients, include sinus tachycardia, sinusbradycardia, accelerated idioventricularrhythm, premature ventricular complexes,ventricular tachycardia, atrial fibrillationand AV blocks. ECG manifestations ofhyperkalaemia (spiked T waves, prolongedPR interval, loss of P waves and wideningof the QRS) may occur in patients withurinary tract dysfunction resulting indecreased urine output e.g. bladderrupture or urethral obstruction.Hyperkalaemia can cause a fatal cardiacarrythmia, so prompt recognition of ECGchanges suggestive of it are crucial. An arrythmia may develop in an ECCpatient for various reasons e.g.hypoperfusion, electrolyte abnormalities,severe pain. If an arrythmia is detected it isimportant to assess the patient’s status,aiming to identify any abnormalities thatmight have caused an abnormal rhythm.

Copyright © 2013 Vets Now Ltd. All rights reservedThe need to treat and the choice oftreatment for cardiac arrhythmias isdependent on various factors such asheart rate, clinical signs, evidence ofperfusion abnormalities, underlying causeand presence of specific ECG changes e.g.multiform complexes or the ‘R on T’phenomenon. Anti-arrhythmic drugs allhave potentially serious side effects, sotheir administration may not be indicateddepending on the severity of thearrythmia and other important patientfactors such as perfusion status, presenceof pain etc. The important thing is to notethe abnormality and react promptly i.e.report to the veterinary surgeon.Arrhythmias 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 arrhythmiawill resolve.Example: A dog could have anaccelerated idioventricular rhythm ifthere are four or more consecutiveventricular ectopic beats/ ventricularpremature contraction (VPCs) but theheart rate is ≤ ~ 140 beats per minute. In the absence of perfusion abnormalitiesattributed to this rhythm, definitivetreatment with an antiarrhythmic drug isnot likely to be warranted as thetreatment may lead to side-effects moreserious than the initial arrythmia.However, maintenance of euvolaemia(normal blood volume), adequateoxygenation, and normal acid-base andelectrolyte status is indicated. Course notes excerpt: Unit 2 Outcome 1: Monitoring the Critical Patient (Feb 2024)

Make sure you are aware of the meaningand can explain each of the followingterms:HypertensionHypotensionArrhythmiaTachycardiaBradycardiaPerfusionPreload and afterloadForward and backward failureInotropeChronotropeCachexiaTamponade’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 cardiovascular disease(e.g. congestive heart failure) that can bethe cause of patients presenting asemergencies. N.B. Some use the term respiratorydifficulty instead of dyspnoea in relation toanimals with breathing difficulties.Dyspnoea is something an individual feels.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. Copyright © 2013 Vets Now Ltd. All rights reservedCourse notes excerpt: Unit 3 Outcome 1: Cardiovascular Emergencies (July 20V)Unit 3 Outcome 1: Cardiovascular Emergencies3.1.1 Introduction3.1.2 TerminologySome of the terminology that will be usedin this outcome is listed below. 3.1.3 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.Emergency Medicine 1

CardiacoutputHeart RateStrokeVolumePreloadContractilityAfterloadTo perform these roles, the cardiovascularsystem must perform three basicfunctions: 1. maintenance of normal systemic andpulmonary arterial blood pressure. 2. maintenance of normal tissueperfusion3. maintenance of normal systemic andpulmonary venous pressuresCardiac output is the volume of bloodpumped from the heart each minute. It isthe product of the heart rate (HR) andstroke volume (SV). SV is the volume ofblood that is pumped by the heart witheach beat. Cardiac Output = HR x SVThe stroke volume is determined by threemain factors: The preload. The volume of bloodwithin the ventricles prior to systole: i.e.the end-diastolic volume.The afterload. Any back pressurecaused by resistance within bloodvessels and organs that restricts thevolume of blood able to leave the heart.The contractility of the heart itself i.e.the heart’s innate strength andelasticity producing the contraction.3.1.3.1 Cardiac outputFrom 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.Course notes excerpt: Unit 3 Outcome 1: Cardiovascular Emergencies (July 20V)Copyright © 2013 Vets Now Ltd. All rights reserved

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. TheBSAVA/VPIS Guide to Common Canineand Feline Poisons is a resource that canalso be purchased by non-members ofBSAVA.This outcome will cover the poisons andtoxins that are the most common cause ofpotential or actual illness in cats and dogs.This document cannot cover all poisonings.It is important to be aware that there is anincreasing range of causes of poisoning inveterinary practice All veterinary practices should haveaccess to a poisons information serviceand a reliable, up-to-date database onpotential sources of poisonsThe 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.Copyright © 2013 Vets Now Ltd. All rights reservedCourse notes excerpt: Unit 5 Outcome 3: Toxicological Emergencies (Intoxications) (June 19V)Unit 5 Outcome 3: Toxicological Emergencies (Intoxications)5.3.1 IntroductionPlease 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 management ofany potential or actual poisoning case. 5.3.2 TerminologyThe terminology can be a bit confusingwith some terms being usedinterchangeably e.g. poison and toxin. Emergency Medicine 3

Some definitions are provided below (Babyakand Lee, 2018).Poison: A substance which can causeharm to a living organism (NOT derivedfrom biological (living) material/organisms)Toxin: A poisonous substance producedby a biological living organism.Venom: A toxin (produced by a livingorganism) which is injected from a livingorganism into another e.g. an Adderbiting a dog.Envenomation: Poisoning by venom (e.g.snake or spider)Toxicity: The ability of something to bepoisonous/ toxic – cause toxicosis; thedegree to which a substance can causedamage to a living organism Toxicosis: The disease state caused bysomething poisonous/ toxicToxic: Poisonous Intoxication: The condition that arisesdue to ingestion of a chemical substancewhich results in altered consciousness,cognition or behaviour e.g. often used inrelation to alcohol.(In)toxicant: A substance which causestoxicosis or intoxication/ often man-made e.g. cleaning product or alcohol.Half-life: The time taken for somethingspecific to have decreased by half (e.g.the plasma level of a poison decreasingas it is excreted). The shorter the half-life,the quicker the product is inactivated orexcreted .Lethal Dose (LD): The amount ofpoisonous product which will causedeath to an animal or human. LD50 –amount of product which would cause50% mortality in a population e.g. drugtrials Antitoxin: A substance (antibody),produced by a living organism thatcounteracts/ neutralises a specifictoxin e.g. tetanus antitoxin.Antivenom: A substance (antibody),produced by a living organism thatcounteracts/ neutralises a specificvenom e.g. adder antiserum.Antidote: A substance whichcounteracts a specific poisonCathartic: A substance which causesemptying of the gastrointestinal (GI)tract e.g. laxative.Dialysis: Method of removing toxinsthat are usually processed andeliminated via the kidneys, until thekidneys improve. There are severalmethods of dialysis Gavage/gastric lavage: Introducingfluid into the stomach via a stomachtube; washing out the stomach using aliquid.Adsorption: The adhesion of asubstance to another surface. Thisproperty can be used to promoteexcretion of a poisonous substancefrom the GI tract rather than it beingabsorbed into the body e.g. activatedcharcoal adsorbs some (but not all)poisons.Copyright © 2013 Vets Now Ltd. All rights reserved

Remember many things have the potentialto be toxic. The main factor is the dose/amount the animal has been exposed to. Ifan animal is known to have ingested apotential poison, one of the key initialconsiderations is trying to identify themaximum amount the animal could haveingested. There are several stages involved in themanagement of the poisoned patient. Theorder in which some of these are performedwill depend on the nature of poisoning andthe patient’s current condition e.g.emergency stabilisation may be requiredprior to a full history being obtained fromthe owner. Lee (2013) highlights the approach to apoisoned patient:Adsorbent: A substance that causesadsorption of another. In a poisoningcase the action of an adsorbent (e.g.active charcoal) can limit absorption of apoison into the body Lipophilic: Affinity for/ attracted to lipids.Babyak and Lee (2018) explain thatexposure to substances that can causetoxicosis in cats and dogs occurs relativelyfrequently.Reasons for this include: 1.The availability of many toxic products inand around the home/ garage e.g.cleaning products, owner medication,car products e.g. antifreeze2.The naturally inquisitive nature of catsand dogs.There are many potential sources of toxins/poisons and, so, reasons for toxicosis arising: EnvironmentalAccidental ingestion e.g. scavengingAccidental overdose e.g. too muchadministered, wrong frequency, poorinstructions Administration of unsuitable medicatione.g. paracetamol to a catMalicious Copyright © 2013 Vets Now Ltd. All rights reservedTelephone triage +/- first aid guidancePrimary triage assessmentFull clinical examination and history takingStabilisation +/- decontaminationFurther treatment

Affordable and flexible,with tutor supportedonline content;Develop your interest in emergency & critical care, with the Cert VNECC. It’s your unique opportunity to build on your existing skills andknowledge to achieve a Level 4, industry recognised qualificationin small animal emergencyand critical care nursing. the Cert VN ECC offersaccessible, inclusive learningwherever you are.April & OctoberAnnual intakes in Apply now at www.vets-now.com/certvnecc