ACCELERATED EMERGENCY PROGRAM

Key Learning Objectives

• Outline the steps involved in the identification and interpretation of acid base disorders
• Identify one of four primary disorders and any compensatory mechanisms or secondary disorders.
• List the causes of respiratory acidosis, respiratory alkalosis, metabolic acidosis and metabolic alkalosis
• Calculate the anion gap and use it to identify causes of metabolic acidosis
• Describe the management of acidaemia and alkalaemia.
• Discuss the physiology of lactate production, its use as a marker of perfusion and the relationship to base excess (BE).
• Describe the pathophysiology underlying the two main types of hyperlactataemia and other potential causes
• Outline oxygenation in terms of arterial blood oxygen (PaO2), ventilation, perfusion and V/Q mismatch
• Recall the physiological causes of low blood oxygen (hypoxaemia) and disease processes causing hypoxemia.
• Calculate the adequacy of oxygenation using the P:F ratio and A-A Gradient
• Describe the assessment of ventilation in relation to PCO2 and the 120 rule

Key Learning Objectives

• Define shock and the physiological causes
• Explain circulatory shock in
•  terms of hypovolemic, cardiogenic, distributive, obstructive shock
• Outline findings in the stages of shock - compensatory, decompensatory, end-stage
• Describe the principles of fluid therapy - including the glycocalyx, Starlings law & formation of interstitial oedema.
• List the goals of fluid therapy in terms of perfusion parameters, dehydration correction and treatment of circulatory shock
• Demonstrate how to assess the degree of dehydration
• List the types of intravenous fluids and their indications for use
• Construct a fluid plan to correct hypovolaemia, dehydration, ongoing losses and maintenance
• Explain indications for bolus and shock fluid rates
• Describe monitoring and perfusion end points for fluid therapy.
• List the potential complications of fluid therapy
• List considerations in perioperative fluid therapy

Key Learning Objectives

• List the main serum electrolytes which need to be monitored and clinically managed
  • sodium
  • calcium
  • potassium
  • phosphate
• Recall normal reference ranges for each electrolyte
• Recall the common causes of abnormal decreases in each electrolytes
• Recall the common causes of abnormal increases in each electrolytes
• Describe the common clinical signs and pathological changes seen with derangements of each electrolytes
• Recognise severity of clinical signs in relation to extent of electrolyte derangement
• Discuss hypernatremia and hyponatremia in terms of volume status
• List the appropriate management and treatment for the common electrolyte disturbances
• Recall the specific calculations used in the management and treatment of sodium disorders

Key Learning Objectives

• Differentiate the various components of a complete blood count
• Outline the interpretation a complete blood count.
• Outline appropriate differential diagnoses for abnormalities in the complete blood count.
• Describe how to perform a blood smear and be able to evaluate findings.
• Interpret a serum biochemistry profile and outline appropriate differential diagnoses for abnormalities.
• Identify factors that may affect clinical pathology results in terms of animal breed, sample artefact and laboratory artefact

• Describe AFAST and TFAST techniques.
• Outline the abdominal fluid scoring system
• Describe and outline the VetBLUE including the acoustic windows
• Identify lung ultrasound signs - A lines, B lines, glide sign
• Describe likely disease processes from VetBLUE using the regionally based respiratory pattern
• Describe focused echocardiography and it’s uses

Key Learning Objectives

• Outline the pathophysiology of the pain pathway and describe the main neurotransmitters
• Recall the three types of pain.
• Identify how to assess pain in terms of the physiological signs and behavioural signs
• Recall use of pain scales in the dog and cat.
• Define multimodal analgesia and pre-emptive analgesia
• Describe the basic pharmacology for commonly used analgesics, their advantages and disadvantages and important considerations.
• Select appropriate analgesic agents for different trauma situations.
• Outline the advantages and disadvantages of two common sedatives and their important considerations.
• List the advantages and disadvantages of commonly used anaesthetic agents.
• Recall considerations for anaesthetic drugs based on common emergency presentations and surgeries.

Key Learning Objectives

• Identify the important components of a triage assessment
• Explain the primary triage survey in the initial assessments and stabilisation of cardiovascular, respiratory and neurological parameters
• Discuss life sustaining interventions and use of point of care diagnostics
• Explain the secondary triage survey and the assessments required after initial stabilisation
• List the clinical signs of cardiopulmonary arrest (CPA)
• Explain basic life support and cardiopulmonary resuscitation (CPR)
• Describe CPR  and recommended techniques for chest compressions and ventilatory support
• Describe monitoring devices used in advanced life support and explain the importance of the main parameters in CPR
• Identify shockable and non-shockable rhythms in CPR and how to treat these.
• Expand upon the indications and doses of common medications administered during CPR.

Key Learning Objectives

• Explain the cell-based model of coagulation
• Describe the pathophysiology of primary haemostasis
• Recall the main disorders of primary haemostasis
• Identify the clinical signs associated with primary haemostatic disorders
• Discuss the diagnostic tests and treatments for primary haemostatic disorders
• Recall the three pathways involved in the coagulation cascade.
• Identify the clinical signs associated with secondary haemostatic disorders
• Discuss the diagnostic tests for and treatment of secondary haemostatic disorders
• Outline the primary mechanisms of anaemia
• Describe the clinical signs of anaemia, diagnostic tests, and the treatment of anaemia.

Key Learning Objectives

• Briefly explain the pathophysiology of congestive heart failure in relation to the common cardiac diseases of the dog and cat
• Describe the common clinical signs seen with cardiac disease
• List the diagnostic tests used to evaluate and assess patients with suspected cardiac disease
• Outline the medical treatments and therapeutic procedures used in the emergency management of a cardiac patient
• Explain the Renin-Angiotensin-Aldosterone System (RAAS) and its importance in maintenance of blood pressure
• Describe the common clinical findings seen with hypertension in dogs and cats
• Describe the common clinical findings seen with hypotension in dogs and cats
• List the diagnostic tests used to assess  and evaluate blood pressure
• Outline the medical treatment options for hypotension and hypertension in dogs and cats

Key Learning Objectives

• Define hypoxaemia , the common causes, relevance in respiratory physiology
• Define hypoxia , causes and relevance in terms of respiratory physiology
• Describe the difference between ventilation and oxygenation measures and explain V/Q mismatch
• List relevant measures for assessment of ventilation and oxygenation including PaO2, SpO2, PaCO2, FiO2
• Explain the oxyhaemoglobin dissociation curve
• Explain the PF ratio in terms of lung function assessment
• Detail a diagnostic approach for a patient presenting in respiratory distress
• Detail a treatment plan for a patient presenting in respiratory distress
• List a range of common disease states of the respiratory system that can present as emergencies

Key Learning Objectives

• Describe the regulation systems of potassium homeostasis
• List the causes and consequences of hyperkalemia
• Discuss the treatment and management of hyperkalemia
• Discuss the causes and consequences of uroabdomen
• List the tests and procedures used in the diagnosis of uroabdomen
• Discuss the management and treatment options for uroabdomen
• Discuss Feline Lower Urinary Tract Disease (FLUTD)including the causes, clinical signs and diagnosis
• Describe the treatment options for FLUTD
• Discuss acute kidney injury in terms of kidney function and pathophysiological changes
• List the veterinary staging systems for acute kidney injury
• Describe the differential diagnosis for acute kidney injury in terms of pre-renal, renal and post-renal causes
• Discuss the treatment, management and monitoring of acute renal injury

Key Learning Objectives

• Describe how to perform a complete ophthalmic assessment
• Discuss the ophthalmic assessment in terms of gross examination techniques
• Discuss the ophthalmic assessments in terms of specialised examination techniques
• List the required equipment and drugs required for a complete ophthalmic assessment
• Describe the pathophysiology and clinical signs of the common ophthalmic emergencies below:
• Discuss the diagnostic workup of the common ophthalmic emergencies below:
• List the treatment and management of specific ophthalmic conditions below:
  • Corneal ulcer/laceration
  • Descemetocele
  • Uveitis
  • Glaucoma
  • Horner’s Syndrome
  • Proptosis

Key Learning Objectives

• Discuss the functional regions of the brain and their neurological assessments
• List the localisation of a brain lesion in relation to the assessments and deficits
• Discuss the functional regions of the spinal cord and their neurological assessments
• List the localisation of a spinal lesion in relation to the assessments and deficits
• Describe how to perform a neurological examination
• Discuss primary and secondary traumatic brain injury including mechanisms of intracranial pressure increases
• List the clinical assessments for traumatic brain injury including the Modified Glasgow Coma Scale
• Discuss the tiered  and specific treatments of traumatic brain injury
• List the diagnostic workup of patients presenting with seizures and status epilepticus
• Discuss the specific treatments of seizures, including status epilepticus
• List the diagnostic workup of patients with suspected intracranial disease
• List the specific treatments meningitis or meningoencephalitis
• and the breeds  commonly affected

Key Learning Objectives

• List the commonly associated history, clinical signs and examination findings in acute abdomen presentations
• Discuss the principles of the general diagnostic workup for an acute abdomen presentation
• Describe the principles of immediate treatment for an acute abdomen presentation
• Discuss Acute Pancreatitis - the pathophysiology, clinical signs, workup and treatment
• Discuss Acute Gastroenteritis - aetiology, clinical signs, differential diagnoses, workup and treatment
• Discuss Gastric Dilation and Volvulus (GDV) - the pathophysiology, clinical signs and diagnostic workup
• List the initial management and surgical considerations of GDV
• List the post-operative management and monitoring of GDV patients
• Discuss Acute Non-Traumatic Haemoabdomen - the pathophysiology, clinical signs, workup and management

Key Learning Objectives:

• Discuss the pathophysiology of diabetic ketoacidosis (DKA)
• Describe the clinical signs, work-up and diagnosis of DKA
• List the common electrolyte, acid-base and fluid derangements see in DKA
• Discuss the treatment of DKA including insulin regimes, fluid therapy, electrolyte supplementation and monitoring
• Discuss the pathophysiology of glucose regulation in the body and causes of hypoglycaemia
• Describe the clinical signs, work-up and diagnosis of hypoglycaemia
• Discuss the treatment of hypoglycaemia
• Discuss the pathophysiology of primary and secondary hypoadrenocorticism
• Describe the clinical signs and diagnostic work-up of hypoadrenocorticism
• List the common clinical abnormalities present in hypoadrenocorticism - including electrolyte, clinical pathology, diagnostic imaging and adrenal-axis testing
• Discuss the emergency treatment and management of patients in ‘Addisonian Crisis’.

Key Learning Objectives

• List the preliminary questions asked in phone triage of suspected intoxications
• Discuss the various decontamination methods including emesis, use of activated charcoal, gastric lavage, dermal decontamination and enhanced elimination
• Describe the complications and contraindications of the above methods
• Discuss the common intoxications below, including the clinical signs, diagnosis, stabilisation, decontamination, specific treatment and monitoring of
  •  Metaldehyde intoxication
  • Synthetic pyrethrin intoxication
  •  Anticoagulant rodenticide intoxication
  • Lily plant intoxication
  • Non-steroidal anti-inflammatory drug (NSAID) intoxication
  • Chocolate/Caffeine intoxication
  • Ethylene glycol intoxication
  • Grape & Raisin intoxication
• Discuss ‘serotonin syndrome’ including the related drugs, the clinical signs, diagnosis, stabilisation, decontamination, specific treatment and monitoring