Subject: Emergency & Critical Care

Week 1

Approach to the Caesarean Patient

Brief overview of parturition

Complications of parturition

Caesarean section

Learning objectives
After completion of this week, participants should be able to:

Explain complications that might occur in parturition

Explain the reasons for intervening in these cases in order to perform a C section

Understand nursing of the caesarean patient

Week 2

The GDV Patient

Physiology of GDV

Diagnosis

Stabilisation of the GDV

Anaesthesia considerations

Post-operative nursing

Learning objectives
After completion of this week, participants should be able to:

Understand the physiology of a GDV and list some of the common risk factors associated with this condition

Describe how a GDV is diagnosed and which tests can help us to identify this condition in the emergency patient

List the common stabilisation techniques in the emergency patient including management of shock and commonly used gastric decompression techniques

Discuss anaesthesia considerations and how to make the patient a safe candidate for surgery

Describe the nursing considerations for the post-operative GDV case and the factors which need to be included in the care plan of the hospitalised patient

Week 3

Nursing the Septic Abdomen Patient

What are SIRS and sepsis?

Recognising sepsis

The use of diagnostic tools in the veterinary practice to help recognise a septic abdomen

Nursing management of a septic abdomen

Learning objectives
After completion of this week, participants should be able to:

Describe SIRS and sepsis and the difference between them

Understand how to recognise sepsis in veterinary patients

List the different tests we have available in practice that can be used to help identify a septic abdomen

Explain how patients with a septic abdomen can best be nursed in practice, pre-, peri and post operatively

Week 4

Haemoabdomen

Physiology of haemoabdomen

Diagnosis

Stabilisation of the haemoabdomen

Anaesthesia considerations

Post-operative nursing

Learning objectives
After completion of this week, participants should be able to:

Understand the physiology of a haemoabdomen and list some of the common causes associated with this condition

Describe how a haemoabdomen is diagnosed and which tests can help us to identify this condition in the emergency patient

List the common stabilisation techniques in the emergency patient including management of shock

Discuss anaesthesia considerations and how to make the patient a safe candidate for surgery

Describe the nursing considerations for the post-operative haemoabdomen case and the factors which need to be included in the care plan of the hospitalised patient

Week 1

Approach to the Caesarean Patient

Brief overview of parturition

Complications of parturition

Caesarean section

Learning objectives
After completion of this week, participants should be able to:

Explain complications that might occur in parturition

Explain the reasons for intervening in these cases in order to perform a C section

Understand nursing of the caesarean patient

Week 2

The GDV Patient

Physiology of GDV

Diagnosis

Stabilisation of the GDV

Anaesthesia considerations

Post-operative nursing

Learning objectives
After completion of this week, participants should be able to:

Understand the physiology of a GDV and list some of the common risk factors associated with this condition

Describe how a GDV is diagnosed and which tests can help us to identify this condition in the emergency patient

List the common stabilisation techniques in the emergency patient including management of shock and commonly used gastric decompression techniques

Discuss anaesthesia considerations and how to make the patient a safe candidate for surgery

Describe the nursing considerations for the post-operative GDV case and the factors which need to be included in the care plan of the hospitalised patient

Week 3

Nursing the Septic Abdomen Patient

What are SIRS and sepsis?

Recognising sepsis

The use of diagnostic tools in the veterinary practice to help recognise a septic abdomen

Nursing management of a septic abdomen

Learning objectives
After completion of this week, participants should be able to:

Describe SIRS and sepsis and the difference between them

Understand how to recognise sepsis in veterinary patients

List the different tests we have available in practice that can be used to help identify a septic abdomen

Explain how patients with a septic abdomen can best be nursed in practice, pre-, peri and post operatively

Week 4

Haemoabdomen

Physiology of haemoabdomen

Diagnosis

Stabilisation of the haemoabdomen

Anaesthesia considerations

Post-operative nursing

Learning objectives
After completion of this week, participants should be able to:

Understand the physiology of a haemoabdomen and list some of the common causes associated with this condition

Describe how a haemoabdomen is diagnosed and which tests can help us to identify this condition in the emergency patient

List the common stabilisation techniques in the emergency patient including management of shock

Discuss anaesthesia considerations and how to make the patient a safe candidate for surgery

Describe the nursing considerations for the post-operative haemoabdomen case and the factors which need to be included in the care plan of the hospitalised patient

Week 1

Monitoring Modalities

There are many advanced monitoring tools and nursing interventions that can be used in our patients, however, a key part of this is deciding when it is appropriate to employ them. We will discuss and compare different monitoring tools that we have available, including:

Blood pressure monitoring – invasive versus non-invasive

Central venous pressure

ECG

Blood gases – venous versus arterial

We will also explore when these monitoring tools may be beneficial compared with when their use might be contraindicated.

Learning objectives
After completion of this week, participants should be able to:

Determine which patients would benefit from more intensive monitoring

Understand how to conduct each kind of monitoring and explain the information we can obtain

Understand the difference between arterial blood pressure monitoring and central venous pressure

Understand the complications of using the more invasive monitoring tools

Week 2

Tubes and Drains

Various tubes and drains are commonly used in critically ill ICU patients, and it is vital we understand how to manage these safely and effectively. We will look at a variety of different tubes and drains including Jackson Pratt drains and active grenades, thoracic tubes, tracheostomy tubes and pericardiocentesis catheters among others.

Learning objectives
After completion of this week, participants should be able to:

Understand the different drains and their functions

Safely manage and nurse patients with various types of tubes

Understand the complications that may occur with various interventions

Confidently troubleshoot drain management

Week 3

Cardiovascular Support

Sometimes fluids just aren’t enough! There are a variety of issues we can encounter with our critically ill patients and cardiovascular support and monitoring becomes an important aspect of the RVN’s role. We will look at the different causes of cardiovascular instability and how we can address those including the use of vasopressors and inotropes.

Learning objectives
After completion of this week, participants should be able to:

Understand the methods of monitoring that can assist with determining both low and high-volume states

Identify cases where the use of vasopressors and inotropes are indicated

Explain the different conditions that lead to changes in cardiovascular function

Understand the ECG assessment and recognise the main life threatening abnormalities

Week 4

Constant Rate Infusions

Constant rate infusions are commonly used in the ICU, and it is really useful for RVN’s to be able to calculate these dosages. Whilst the maths can sometimes seem baffling, if you understand the basics, it is a very useful skill. CRIs are very beneficial for many of our patients and are attainable in any practice with an infusion pump.

Learning objectives
After completion of this week, participants should be able to:

Calculate ANY CRI from scratch!

Understand the benefits and issues associated with use of CRIs

Understand multimodal analgesia options for critically ill patients

Week 1

Monitoring Modalities

There are many advanced monitoring tools and nursing interventions that can be used in our patients, however, a key part of this is deciding when it is appropriate to employ them. We will discuss and compare different monitoring tools that we have available, including:

Blood pressure monitoring – invasive versus non-invasive

Central venous pressure

ECG

Blood gases – venous versus arterial

We will also explore when these monitoring tools may be beneficial compared with when their use might be contraindicated.

Learning objectives
After completion of this week, participants should be able to:

Determine which patients would benefit from more intensive monitoring

Understand how to conduct each kind of monitoring and explain the information we can obtain

Understand the difference between arterial blood pressure monitoring and central venous pressure

Understand the complications of using the more invasive monitoring tools

Week 2

Tubes and Drains

Various tubes and drains are commonly used in critically ill ICU patients, and it is vital we understand how to manage these safely and effectively. We will look at a variety of different tubes and drains including Jackson Pratt drains and active grenades, thoracic tubes, tracheostomy tubes and pericardiocentesis catheters among others.

Learning objectives
After completion of this week, participants should be able to:

Understand the different drains and their functions

Safely manage and nurse patients with various types of tubes

Understand the complications that may occur with various interventions

Confidently troubleshoot drain management

Week 3

Cardiovascular Support

Sometimes fluids just aren’t enough! There are a variety of issues we can encounter with our critically ill patients and cardiovascular support and monitoring becomes an important aspect of the RVN’s role. We will look at the different causes of cardiovascular instability and how we can address those including the use of vasopressors and inotropes.

Learning objectives
After completion of this week, participants should be able to:

Understand the methods of monitoring that can assist with determining both low and high-volume states

Identify cases where the use of vasopressors and inotropes are indicated

Explain the different conditions that lead to changes in cardiovascular function

Understand the ECG assessment and recognise the main life threatening abnormalities

Week 4

Constant Rate Infusions

Constant rate infusions are commonly used in the ICU, and it is really useful for RVN’s to be able to calculate these dosages. Whilst the maths can sometimes seem baffling, if you understand the basics, it is a very useful skill. CRIs are very beneficial for many of our patients and are attainable in any practice with an infusion pump.

Learning objectives
After completion of this week, participants should be able to:

Calculate ANY CRI from scratch!

Understand the benefits and issues associated with use of CRIs

Understand multimodal analgesia options for critically ill patients

Week 1

Vascular Access

Indications for IV placement

Different types of IV catheter

Different placement techniques

IV catheter management

Complications

Learning objectives
After completion of this week, participants should be able to:

List the indications and contraindications for IV catheter placement

Understand the difference between peripheral and central venous catheterisation

Describe the different IV catheter options currently on the veterinary market and their placement technique

Discuss how to manage IV catheters – both peripheral and central

Describe the common complications associated with IV catheters and how to minimise them

Week 2

Urinary Catheters

Indications for placing urinary catheters

Different types of urinary catheters

Placement of urinary catheters

Urinary catheter management

Complications

Learning objectives
After completion of this week, participants should be able to:

List the indications and contraindications for urinary catheter placement

Describe the different urinary catheter options currently for veterinary use

Explain how urinary catheters are placed

Discuss how to manage urinary catheters in practice

Describe the common complications associated with urinary catheters

Week 3

Chest Drains

When chest drains are placed

Different types of chest drain

Different placement techniques

Chest drain management

Complications

Learning objectives
After completion of this week, participants should be able to:

List the indications and contraindications for chest drain placement

Describe the different chest drain options currently on the veterinary market and their placement techniques

Explain how to drain the chest drain and what options are available should the patient have a continuous pneumothorax

Discuss how to manage the chest drain and how to identify a drain that is ready for removal

Describe the common complications associated with chest drains and how to minimise them

Week 4

Tracheostomy Tubes

Indications for tracheostomy tube placement

Different types of tracheostomy tubes

Placement of tracheostomy tubes

Management of tracheostomy tubes

Complications

Learning objectives
After completion of this week, participants should be able to:

List the indications and contraindications for placing tracheostomy tubes

Understand the different types of tracheostomy tubes available for veterinary use

Describe how tracheostomy tubes are placed

Explain how to manage tracheostomy tubes in situ

Describe the common complications associated with tracheostomy tubes in practice

Week 1

Transfusion Medicine

This week we will look at indications for packed red cell and whole blood transfusions, in both cats and dogs, in the acute emergency setting.  The nurse’s role is vital in this field, including preparing the recipient, blood typing, cross matching and monitoring the recipient.  We will cover common reasons for transfusion and patient specific nursing concerns, as well as indications for auto transfusion and xenotransfusion.   Common coagulopathies will also be discussed, along with indications for the use of plasma products in small animal patients.

Learning objectives
After completion of this week, participants should be able to:

Select the correct blood product for the individual patient

Understand the monitoring these patients require and patient specific concerns

Explain the different transfusion reactions that can occur and how they are avoided and treated

List the indications for auto transfusion and xenotransfusion

Describe the main coagulopathies we encounter and the treatment options available

Week 2

Acute Kidney Injury

Acute kidney injury is a relatively common presentation in emergency and critical care, however, it can occur for a variety of reasons.  This week will look at the conditions that lead to acute kidney injury and how we reach that diagnosis.  We will look at treatment options including reviews of the evidence bases in terms of patients that are anuric. The nursing role in these patients is multi- faceted and it is vital we can monitor and nurse these patients effectively.

Learning objectives
After completion of this week, participants should be able to:

Understand the different reasons that AKI develops, including post-surgery, toxin related and obstruction of the urinary tract

Understand the monitoring and nursing requirements of these patients including fluid therapy, acid-base status and how we recognize when they are deteriorating

Explain how we manage anuric patients including evidence reviews of methods to force diuresis

Understand the basics of peritoneal and haemodialysis for these patients and the indications

Week 3

Diabetic Ketoacidosis

DKA is a complex disorder that can be life threatening for our patients, and the nursing team play a large role in the management and recovery of these patients. There are multiple considerations in nursing a patient with DKA that go well beyond administering insulin. We will review common reasons for a patient to develop this endocrine disorder as well as acid- base and electrolyte abnormalities we may see.

These patients need intensive monitoring including repeated blood work so we will discuss how to minimize the impact of this on their welfare. There will also be discussion on the different approaches to administration of insulin and ongoing management of these cases when they are discharged home.

Learning objectives
After completion of this week, participants should be able to:

Recognise the concurrent conditions that may lead to difficulty stabilizing the DKA patient

Understand how we reach the diagnosis and the treatment priorities for these patients

Understand the different approaches to insulin administration as well as the pros and cons of each method

Explain how to prioritise appropriate monitoring for these patients

Week 4

Acute Pancreatitis

The pancreatitis patient is a common presentation to any practice. It is an inflammatory condition that can be classed from mild to severe.  We will focus on the nursing care and assessment of the patients requiring hospitalisation for management.  Whilst we often consider these patients as just needing a couple of days of supportive care, there are some serious complications that can occur and contribute to mortality.

Learning objectives
After completion of this week, participants should be able to:

Understand common aetiologies in dogs and cats

Review pain management options including drug types and routes of administration

Discuss nutritional support options

Identify complications including development of SIRS

Week 5

Acute Respiratory Distress

These patients present many challenges to us in practice and need some special consideration in terms of monitoring and nursing care.  We will look at recognition of the patient in respiratory distress, the potential causes, and our priorities for treatment.  We will review the monitoring tools that may be beneficial and our approach to stabilising these patients.

Learning objectives
After completion of this week, participants should be able to:

Prioritise stabilisation techniques based on patient presentation

Determine which method of oxygen supplementation is most appropriate for specific patients

Appreciate the management of patients in brachycephalic crisis

Understand the different approaches to diagnostics and monitoring for these very fragile patients

Week 6

Addisonian Crisis

Known as the “great pretender”, Addison’s disease leads to a potentially life-threatening situation when the patient goes into crisis.  Whilst electrolyte abnormalities are present in a typical Addisonian we can see no electrolyte changes in atypical cases.  The patient with an Addison’s crisis has multiple abnormalities which we need to monitor and correct.  Consideration of management options for these patients as well as resolving the crisis will all be discussed.

Learning objectives
After completion of this week, participants should be able to:

Understand the aetiology, common clinical signs, and effects of this complex disorder

Identify and differentiate a patient that has Addison’s disease, with a patient in an Addisonian crisis

Understand the nursing considerations for these patients in the hospital environment, and appreciate the impact stress hormones have

Identify priorities for treatment and ongoing management

Week 1

Transfusion Medicine

This week we will look at indications for packed red cell and whole blood transfusions, in both cats and dogs, in the acute emergency setting.  The nurse’s role is vital in this field, including preparing the recipient, blood typing, cross matching and monitoring the recipient.  We will cover common reasons for transfusion and patient specific nursing concerns, as well as indications for auto transfusion and xenotransfusion.   Common coagulopathies will also be discussed, along with indications for the use of plasma products in small animal patients.

Learning objectives
After completion of this week, participants should be able to:

Select the correct blood product for the individual patient

Understand the monitoring these patients require and patient specific concerns

Explain the different transfusion reactions that can occur and how they are avoided and treated

List the indications for auto transfusion and xenotransfusion

Describe the main coagulopathies we encounter and the treatment options available

Week 2

Acute Kidney Injury

Acute kidney injury is a relatively common presentation in emergency and critical care, however, it can occur for a variety of reasons.  This week will look at the conditions that lead to acute kidney injury and how we reach that diagnosis.  We will look at treatment options including reviews of the evidence bases in terms of patients that are anuric. The nursing role in these patients is multi- faceted and it is vital we can monitor and nurse these patients effectively.

Learning objectives
After completion of this week, participants should be able to:

Understand the different reasons that AKI develops, including post-surgery, toxin related and obstruction of the urinary tract

Understand the monitoring and nursing requirements of these patients including fluid therapy, acid-base status and how we recognize when they are deteriorating

Explain how we manage anuric patients including evidence reviews of methods to force diuresis

Understand the basics of peritoneal and haemodialysis for these patients and the indications

Week 3

Diabetic Ketoacidosis

DKA is a complex disorder that can be life threatening for our patients, and the nursing team play a large role in the management and recovery of these patients. There are multiple considerations in nursing a patient with DKA that go well beyond administering insulin. We will review common reasons for a patient to develop this endocrine disorder as well as acid- base and electrolyte abnormalities we may see.

These patients need intensive monitoring including repeated blood work so we will discuss how to minimize the impact of this on their welfare. There will also be discussion on the different approaches to administration of insulin and ongoing management of these cases when they are discharged home.

Learning objectives
After completion of this week, participants should be able to:

Recognise the concurrent conditions that may lead to difficulty stabilizing the DKA patient

Understand how we reach the diagnosis and the treatment priorities for these patients

Understand the different approaches to insulin administration as well as the pros and cons of each method

Explain how to prioritise appropriate monitoring for these patients

Week 4

Acute Pancreatitis

The pancreatitis patient is a common presentation to any practice. It is an inflammatory condition that can be classed from mild to severe.  We will focus on the nursing care and assessment of the patients requiring hospitalisation for management.  Whilst we often consider these patients as just needing a couple of days of supportive care, there are some serious complications that can occur and contribute to mortality.

Learning objectives
After completion of this week, participants should be able to:

Understand common aetiologies in dogs and cats

Review pain management options including drug types and routes of administration

Discuss nutritional support options

Identify complications including development of SIRS

Week 5

Acute Respiratory Distress

These patients present many challenges to us in practice and need some special consideration in terms of monitoring and nursing care.  We will look at recognition of the patient in respiratory distress, the potential causes, and our priorities for treatment.  We will review the monitoring tools that may be beneficial and our approach to stabilising these patients.

Learning objectives
After completion of this week, participants should be able to:

Prioritise stabilisation techniques based on patient presentation

Determine which method of oxygen supplementation is most appropriate for specific patients

Appreciate the management of patients in brachycephalic crisis

Understand the different approaches to diagnostics and monitoring for these very fragile patients

Week 6

Addisonian Crisis

Known as the “great pretender”, Addison’s disease leads to a potentially life-threatening situation when the patient goes into crisis.  Whilst electrolyte abnormalities are present in a typical Addisonian we can see no electrolyte changes in atypical cases.  The patient with an Addison’s crisis has multiple abnormalities which we need to monitor and correct.  Consideration of management options for these patients as well as resolving the crisis will all be discussed.

Learning objectives
After completion of this week, participants should be able to:

Understand the aetiology, common clinical signs, and effects of this complex disorder

Identify and differentiate a patient that has Addison’s disease, with a patient in an Addisonian crisis

Understand the nursing considerations for these patients in the hospital environment, and appreciate the impact stress hormones have

Identify priorities for treatment and ongoing management

Week 1

Patient Assessment and Triage

The concept of triage

Preparedness

Primary survey

Secondary Survey

Emergency history

Learning objectives
After completion of this week, participants should be able to:

Understand the triage process and how it can be utilised to prioritise emergency care

Describe how to make their team and environment prepared for when the emergency patient arrives

List how to carry out a primary survey during the initial assessment of the patient

Explain how to carry out a secondary survey assessment in order to list their concerns with the patient

Discuss how to communicate with the client including telephone advice, informed consent and emergency history

Week 2

Shock

Classify shock

Emergency database

Blood pressure

Oxygen therapy

The use of multiparameter monitors

Learning objectives
After completion of this week, participants should be able to:

Identify a patient with shock and classify which type of shock they have

Explain which parameters may be tested during an emergency database and how these can help to identify shock in the emergency room

Understand the physiology of perfusion and ways in which blood pressure can be monitored in the emergency patient

List the different ways that oxygen therapy can be delivered to the emergency patient

Understand the uses and limitations of multiparameter monitors and their role in monitoring perfusion trends

Week 3

Fluid Therapy

Patient assessment

Identifying a fluid deficit or change in volume

What fluids are available

Managing a change in content

Identifying a change in fluid distribution

Learning objectives
After completion of this week, participants should be able to:

Explain how to assess the patient’s fluid status using clinical exam and blood work

Discuss how to create a fluid plan to treat a fluid deficit such as hypovolaemia or dehydration

List what fluid options are available and which fluid might be preferred in which situation

Understand how fluid selection or the fluid plan can be altered to account for an electrolyte abnormality

Describe how to manage the patient with fluid overload or peripheral oedema

Week 4

Neurological Emergencies

Neurological assessment

Coma scoring

Raised intracranial pressure

Seizures

Learning objectives
After completion of this week, participants should be able to:

Describe how to perform a neurological assessment of an emergency patient

Describe how to perform a coma score and understand how these may be used in neurological patients

Understand methods of identifying raised intracranial pressure and the physiology behind this

Recognise a seizuring patient and understand their management, from initial presentation and stabilisation of mild seizures through to the management of a patient in status epilepticus

Week 5

Approach to the Trauma Patient

Assessment of wounds

Wound management

Management of fractures

Other injuries associated with trauma

Analgesia

Learning objectives
After completion of this week, participants should be able to:

Identify different wounds based on the patient history and appearance of the wound

Understand the principles of wound management and common techniques used to flush and debride wounds

Describe how to identify and manage fractures in the trauma patient

List other common injuries associated with trauma and how these should be managed

Implement an analgesia plan for the trauma patient based on pain assessment

Week 6

Common Toxicities

Common toxins seen in emergency practice

Renal toxins

Hepatotoxins

Anticoagulants

Neurotoxins

Learning objectives
After completion of this week, participants should be able to:

Describe the different ways toxins can enter the body

List the most common renal toxins and understand the treatment of these patients

List the most common hepatotoxins and understand the different treatments for each of these

Understand the physiological effects of anticoagulant ingestion and the treatment of these patients

Identify the most common neurotoxins seen in practice and understand the treatment of these patients