Emergency Medicine with Drs Sandra Forsyth and Trudi McAlees

• Introduction
• Timetable for Modules
• Content of Modules
• Reading List
• Technical Requirements for Online Study
• Register for this Course
  

Welcome to the Emergency Medicine Distance Education Program. This course covers aspects of anaesthesia, critical patient care and intensive care. It is geared towards the practitioner and what I believe can be easily accomplished in general practice. Some of you may be beyond the basics and might find that the references at the back, which have indepth information, are more useful.

Key Benefits

By the end of this course you can expect to:

• Develop appropriate fluid therapy plans; discussion of the benefits of different fluid types.
• Learn to perform emergency procedures such as thoracocentesis, pericardiocentesis, and placing a tracheostomy tube.
• Learn to perform diagnostic procedures in the emergency setting.
• Learn to take and prepare 'cage-side' clinical pathology samples that will be useful.
• Gain confidence dealing with teh acutely dyspnoeic patient.
• Deal confidently with the 'acute abdomen'.
• Learn how to manage wounds to optimise healing and reduce infection.
• Gain confidence dealing with animals presenting after trauma.
• Analgesia-what to use, when to use it, and how much to give.
• Toxicology.
• Blood transfusions.
• Increase your knowledge of CPR.

A list of what you can find in each module follows:

Module 1: General Set-up of a Critical Care Area, Toxicities and Envenomations.
The first module is divided into two main sections.
Firstly we will deal with setting up an emergency triage station and what you need to do to effectively care for critical patients in your practice.

• Drugs and equipment useful for this area, recording systems and
• Basic diagnostics that you should be able to achieve for your emergency patients.

Secondly we will go on to discuss the general triage of the patient with a suspected intoxication.

• Specific treatment of some of the more commonly encountered intoxications in small animals: metaldehyde, anticoagulant rodenticides, herbicides, paracetamol, organophosphates, chocolate toxicity, pyrethroids, ethylene glycol, garbage intoxication.
• Some of the more unusual poisonings you will see but find it hard to get information on eg macadamia nut poisoning, tetanus.

There will be details on the diagnosis and treatment of envenomations: tick paralysis, elapid snake bites, and bee stings.

Module 2: Treatment of Shock, Fluid Therapy, and Blood Transfusions
The definition, recognition and treatment of shock will be discussed.

• The various types of shock will be reviewed: hypovolaemic, distributive including septic, cardiogenic
• How to best treat and monitor animals in the different types of shock.

Fluid therapy is the mainstay of emergency therapy. We use fluids on an almost daily basis during anaesthesia, to treat illnesses and for rehydration.

• Discussion on acid-base and electrolyte imbalances,
• How to set up a fluid plan to treat various conditions
• How to assess which fluid is the right one to use and when.
• The use of crystalloids, colloids, hypertonic solutions and blood products.

Transfusion Medicine

• When and how to use blood products in cats and dogs.
• Discussion of cross matching and blood typing prior to transfusion, blood collection and the use of products available from blood banks will be included.

Module 3: Acute Abdominal Disease and Nutrition
The emergency management and care of patients with acute abdominal disease.

• General information such as potential causes of an acute abdomen, and how to approach a diagnosis.
• How to perform abdominocentesis and a diagnostic peritoneal lavage.
• The management of different critical abdominal diseases such as GDV, Pancreatitis, Prostatic disease, Pyometra, Hepatic disease, and abdominal trauma (including uroabdomen).
• The medical stabilisation of the porto-systemic shunt patient.

The final part of the module will be on the importance of nutrition in our critically ill patients.

• Practical methods you can use in feed anorexic animals eg facial fractures, head trauma, post oesophageal foreign body removal.
• Placement of nasogastric, oesophagostomy and gastrostomy tubes
• The emphasis will be on enteral nutrition - after all, if the gut works, we should be using it!

Module 4: Cardiovascular and Respiratory Disease.
These two subjects are dealt with in one module as they often present to you in the same way:

The animal with acute respiratory distress.

• The emergency treatment and the initial work-up of the dyspnoeic patient.

Respiratory Disease:

• How to differentiate and treat primary and secondary lung disease, obstruction of the upper airways, pleural space disease, and thoracic trauma.
• When and how to place a tracheostomy tube.
• Respiratory support: when and how to assist with ventilation and supplement oxygen in these patients.
• The emergency presentation of the brachycephalic patient.

Cardiac disease:

• Emergency treatment of animals with decompensation heart disease eg mitral valve insufficiency, cardiomyopathy.
• Cardiac drugs: what to use when. Contraindications for selected cardiac drugs.
• Interpretation of common abnormalities of the ECG: bradyarrhythmias, sinus tachycardia, atrial fibrillation, heart block, ectopic ventricular beats. When to intervene when ECG abnormalities are seen.
• Cardiac tamponade including when and how to perform pericardiocentesis.

Module 5: Clin Path: bleeding and anaemia|

Module 6: Clin Path: cytology

Module 7: Metabolic and Endocrine Emergencies, Urinary Tract Disease
This module is again divided in to two main sections. The first one will deal with the emergency presentation of selected metabolic crises and endocrinopathy's:

• Diabetes and the diabetic ketoacidotic patient. How to stabilise these patients.
• Hyperadrenocorticism and Hypoadrenocorticism. Discussion of the various syndromes that Cushing's patients may present with including iatrogenic Addison's disease. Recognition and treatment of the Addisonian crisis.
• Hyper- and hypo- calcaemia
• Hyper- and hypo- thyroidism.
• Some of the more unusual metabolic emergencies: insulinoma's, phaeochromocytoma's.

The second part of the module will deal with emergencies involving the urinary tract:

• The importance of monitoring urinary output in the critically ill animal.
• Urinary tract trauma: the diagnosis of urinary tract rupture. Stabilisation of patients with a ruptured urinary tract.
• Acute renal failure: what to do if urine output is falling.
• Peritoneal dialysis: when is it a good idea?
• Urethral obstruction
• Dealing with urinary retention eg after unblocking the male cat, spinal injuries. Drugs to use to get the bladder functioning again.

Module 8: CPR and Analgesia
Cardiopulmonary arrest (CPA) is an absolute emergency. To ensure the best outcome, reaction times need to be fast so you need to be prepared ahead of time.

• Preparing a "crash cart" so you have everything on hand you need to deal with the CPA
• Causes and clinical signs associated with CPA
• When to attempt CPR, ad when to stop.
• "open" vs. "closed" CPR Basic life support techniques: ABC's and the DEF's.
• Managing the post-resuscitation patient

The second section is on pain and analgesia in the cat and dog.

• Why pain is bad, and analgesia is good.
• The use of analgesics in small animals: opioids, NSAID's, other drugs and non-pharmacological methods of pain treatment. Doses, routes and dose frequencies will be given.
• Local anaesthetics

Module 9: Multi-system Trauma and Wound Management
The triage and assessment of the traumatised animal. The hit by car cat or dog that arrives recumbent and bleeding - what do you do first?

• Basic first aid Assessment of the injured animal on a system by system basis
• What to look for in road traffic accidents, dog attacks, penetrating injuries, and pharyngeal stick injuries.
• Talking to the owner: how much will it cost and will the animal get better?
• Diagnostics
• Monitoring to make sure things are not going bad.

Wound Management.

• The debridement and dressing of surface wounds. A discussion of some of the dressing materials available. What they are designed to do and which are the best dressings for the different stages of wound healing.
• Management of the open fracture
• Burns
• Infected and necrotic wounds

Module 10: Intracranial and Extracranial Neurological Disease, Ocular Emergencies
The emergency management of diseases and injuries affecting the nervous system is divided into those conditions affecting the brain, and those affecting the peripheral nervous system.

• Performing a neurological examination including the cranial nerves: how to localise the lesion.
• Treatment and diagnosis of brain diseases including the seizuring patient, the head trauma patient, meningitis, vestibular disease, GME and other "white shakers".
• The acutely paralysed dog: the differential diagnoses. How to differentiate a disc, an FCE, polyradiculoneuropathy etc.
• Staging of spinal disease: is this surgical?

The final section covers the recognition and treatment of ocular emergencies: Proptosis, glaucoma, penetrating eye injuries, deep corneal ulcers, and hyphema.

Textbooks which may be of interest:

1 Veterinary Emergency and Critical Care
RJ Murtaugh, PM Kaplan (editors)
Mosby Year Book, St Louis, 1992

2 Veterinary Clinics of North America (Small Animal Practice)
Emergency Medicine Volume 24 Number 6
R Kirby, DT Crowe (editors)
WB Saunders Company, Philadelphia, 1994

3 Manual of Canine and Feline Emergency and Critical
Care L. King, R Hammond (editors)
British Small Animal Veterinary Association, 1999

4 Emergency Procedures for the Small Animal Veterinarian
S.J. Plunkett
WB Saunders Company, Philadelphia, 2000

5 Manual of Small Animal Anaesthesia and Analgesia
C. Seymour, R. Gleed (editors)
British Small Animal Veterinary Association, 1999

6 Veterinary Anaesthesia 9th Edition
LW Hall, KW Clarke
Bailliere Tindall, London, 1991

7 Small Animal Anaesthesia: the increased risk patient
PGC Bedford (editor)
Bailliere Tindall, London, 1991

8 Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment
SI Bistner, RB Ford
WB Saunders Company, Philadelphia, 1995

9 Veterinary Emergency Critical Care Manual
Karol A Mathews
Lifelearn

10 Critical Care
Robert Murtaugh
Teton NewMedia
This book can be purchased at the Post Graduate Foundation. Call us on: (02) 9351 7979.

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