Week 1

Traumatic Brain Injury (TBI)

Traumatic brain injury is a relatively common emergency presentation following road traffic accidents or other traumatic episodes. There are several priorities to consider when nursing these patients, which are vital to support their recovery.  We will discuss the initial approach to these patients including the use of mannitol and hypertonic saline, along with analgesia and specific nursing techniques that minimise intra-cranial pressure. Use of the Glasgow Coma Scale is very helpful in these patients and should be part of our toolbox. Ongoing patient care beyond the first 24 hours will be discussed, including options for nutritional support and continued management.

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

Determine the difference between a patient with TBI compared to those with facial trauma or altered mentation for another reason

Understand the difference between primary and secondary brain injury

Appreciate the interventions that will make these patients worse and how to mitigate that risk

Confidently conduct a neurological assessment to complete the Glasgow Coma Scale assessment

Understand the ongoing problems these patients may encounter and how to resolve them

Week 2

Heat Stroke

Despite several media campaigns, we continue to see patients presenting with heat stroke every year.  The nursing team are vital to the recovery and ongoing management of these patients and rapid recognition at triage can lead to improved outcomes. We will look at methods for cooling these patients, the issues we may encounter with them on presentation but also the potential for complications such as Systemic Inflammatory Response Syndrome (SIRS) and Disseminated Intravascular Coagulation (DIC).

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

Determine the difference between heat stroke, heat stress and pyrexia

Understand the priorities for treatment of these patients

Discuss effective cooling methods by reviewing the evidence bases available

Understand the complications associated with heat stroke including development of SIRS and DIC

Week 3

Common Intoxications

Intoxication is a common emergency presentation and the range of toxins our patients can encounter in the environment and the home is very variable. We will look at the toxins that are most encountered and how we need to approach and address these including nephrotoxins and CNS toxins.  We will look at treatment considerations including the use of intravenous lipid emulsion and the evidence supporting its use. Ongoing patient management and monitoring will be discussed in detail.

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

Understand the approach to the intoxicated patient and our priorities

Explain how intravenous lipid emulsion works and which patients it may be suitable for

Provide nursing care for the patient requiring prolonged sedation or anaesthesia due to intoxication

Effectively monitor the patient depending upon the toxin that has been ingested

Week 4

BOAS Crisis

We see an increasing number of brachycephalic patients presenting in respiratory distress. It is vital we are confident at managing these patients from initial admission to stabilisation and ongoing management. We will discuss the anatomy that leads to airway obstruction and the priorities when we are faced with a patient in a BOAS crisis. When to anaesthetise and intubate is a vital consideration as well as when we might consider placing a tracheostomy tube.

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

Understand the conformation issues and environmental factors that may lead to a BOAS crisis

Identify other complications associated with the syndrome and explain how to manage them, including regurgitation and hiatal hernia

Confidently manage a tracheostomy tube patient and understand the indications for placement