Approved
Board of Examiners Minute
FELLOWSHIP GUIDELINES
EMERGENCY MEDICINE and CRITICAL CARE (EMCC)
ELIGIBILITY
1.
The candidate shall meet the eligibility prerequisites for Fellowship outlined in the Blue
Book.
2.
Membership of the College must be achieved prior to the Fellowship examination.
3.
Membership may be in any discipline.
OBJECTIVES
To demonstrate a detailed knowledge and specialist level of competence in management of
emergency conditions and critical illness in the small animal patient. The overall level of training,
knowledge and experience should be sufficient to be recognised by colleagues and State Veterinary
Boards as a specialist in Emergency and Critical Care (Small Animal) at an international level.
DESCRIPTION (LEARNING OUTCOMES)
Definitions
Emergency: those conditions occurring which threaten the life of the patient within a short period
of time, usually minutes to hours.
Critical illness: those conditions which may persist for hours to days, and may be manifestations
of acute or chronic illnesses, but are nevertheless life threatening.
Emergency and Critical Care: that discipline of veterinary medicine which focuses upon
diagnosis and resolution of problems in both emergency and critically ill patients, requiring the
veterinarian to utilise and accomplish skills from the various traditional disciplines.
A candidate is expected to have training, knowledge and experience sufficient to be recognised by
colleagues as a specialist in Emergency and Critical Care (Small Animal). A candidate for
Fellowship in Emergency and Critical Care (Small Animal) is expected to
1. Know the diagnosis, differential diagnosis and treatment of emergency conditions in the dog
and cat.
2. Know the principles of emergency management, such as triage and resuscitation, and
application of primary support techniques.
3. Know the aetiology, pathogenesis and pathophysiology of problems in critically ill patients,
such as fluid and transfusion therapy, multiple organ failure, sepsis and principles of oxygen
delivery.
4. Know canine and feline anatomy and physiology.
5. Know surgical anatomy and pathology related to emergency conditions.
6. Know – internal medicine, surgery, clinical pathology, pharmacology, anaesthesia and
radiology/imaging – as they apply to the diagnosis and management of emergency and
critically ill small animal patients.
7. Be competent at and apply clinical skills and expertise in emergency and critical care, both
diagnostic and procedural (refer to the Clinical Skills and Procedures checklist).
Demonstrated a knowledge of, and an ability to critically evaluate, the relevant current veterinary
and human literature.
EXAMINATIONS
Refer to the Blue Book.
In addition to the Requirements of the Blue Book, the EMCC Fellowship Guidelines impose the
following additional requirements:
1. The Clinical/Practical and Oral Examinations must be of a combined duration of at least three
hours.
2. The Clinical/Practical Examination may consist of a mixture of radiographs, ultrasound, ECGs,
cytology, kodachromes, computer based problem solving, and clinical path data with associated
questions. Written and oral case presentations may be included. The above categories should be
viewed as a guide – the scope of the examination will not necessarily be restricted to these topics or
types of data.
TRAINING PROGRAMS
Refer to the Blue Book
In addition to the Requirements of the Blue Book, the EMCC Fellowship Guidelines impose the
following additional requirements:
CONFORMING PROGRAM
1. This will take the form of a structured full-time residency training program over 2-3 years. A
full-time training program will consist of a minimum of 96 weeks of full-time, directly supervised
training in emergency/critical care and allied specialties. In addition, candidates will complete 25
weeks of independent study or practice (see definition below).
2. The training program should be at an approved facility which has facilities for appropriate
supervision and training of candidates. The candidate should be closely supervised by senior staff
particularly in the first year of the training program. The supervisor must be a registered specialist
or diplomate in the area of emergency/critical care and approved by the FTCC.
3. Residency requirements: The following minimum standards must be met. The sum total of
sections a, b and c below add up to 121 weeks.
a. The minimum 76 weeks of directly supervised training in Emergency and Critical Care
by an approved supervisor (see above). For the purposes of these guidelines for training in
Emergency and Critical Care, directly supervised training is as defined in the Blue Book
with the added requirement that the resident and supervisor are both on duty and
concurrently managing cases for a minimum of 20 hours per week.
b. Twenty (20) weeks of directly supervised training in related specialties, supervised by a
specialist (or equivalent) in that specialty discipline. The following core rotations and time
periods must be completed:
Surgery
6 weeks
Internal medicine
4 weeks
Cardiology
2 weeks
Anaesthesia
4 weeks
Diagnostic imaging 2 weeks
Electives
2 weeks
Total:
20 weeks
The final two weeks are elective and can be chosen from the areas of neurology,
ophthalmology, oncology and clinical pathology.
c. Twenty-five (25) weeks of independent study or practice. Independent study or practice
is defined as full-time work in a facility that complies with the minimum standards for 24
hour facilities. This work may focus on clinical practice, clinical research, teaching or
supervisory duties. Direct daily contact with the supervisor is not required but a
case/activity log must be maintained throughout this period.
Details of the work to be undertaken during this period must be clearly indicated in the
training program submission. It is acceptable to provide this information at some time after
the initial approval of the program if the details of this section of the training are yet to be
finalised. This should be indicated in the initial training program submission.
ALTERNATIVE (NON-CONFORMING PROGRAM)
1. Alternative programs must be documented in detail and approved by the FTCC prior to
commencement of the program. The supervisor must be a registered specialist or diplomate in the
area of emergency/critical care and approved by the FTCC.
2. Guidelines for the structure of the alternative training programs are stipulated in the Blue Book.
3. As at May 2001, alternative programs are unlikely to be available due to lack of suitably
qualified staff in Australia and New Zealand.
REQUIREMENTS FOR TRAINING PROGRAMS
For both conforming and alternative (non-conforming) training programs, the candidate must fulfil
the following requirements to be eligible for the Fellowship examination:
1. Clinical Material Requirements
a. Training programs should provide intensive training in emergency and critically ill patient
management at a referral level.
b. The candidate should acquire a sound general knowledge of canine and feline physiology,
anatomy and a comprehensive knowledge of the underlying principles of emergency and critical
care.
c. The candidate should acquire a detailed knowledge of the aetiology, pathogenesis,
pathophysiology, diagnosis, differential diagnosis and treatment of emergency conditions and
critical problems in the dog and cat from case management, directed study, interaction with other
specialists and clinical seminars.
d. The candidate should be actively involved in the diagnosis and management of clinical cases
involving all body systems. The candidate should acquire an understanding and working
knowledge of relevant diagnostic methods including radiology, ultrasound, endoscopy, clinical
pathology and electrocardiography. The candidate should acquire a sound knowledge of patient
monitoring equipment such as pulse oximetry, non-invasive and invasive blood pressure monitors
and end-tidal CO2.
2. Case Log Requirements
See the section of this document entitled "Activity Log Categories".
3. Theoretical Background Requirement
3a. Structured Education
The resident must provide written documentation that two of the three criteria listed below have
been satisfied:
(i) The resident has actively participated for a minimum of two years in medical seminars, clinical
case conferences, morbidity/mortality rounds and review sessions on a wide range of topics related
to emergency and critical care (see attached schedule). The resident must also receive mentored
exposure to critical evaluation of the scientific literature (literature review or journal club). There
should be heavy input into the seminar series by individuals other than the resident. This training
may be received at a veterinary or human teaching hospital. All seminars and conferences must be
documented (title, date, location, speaker, length). This experience must comprise at least 100
hours of seminars, accrued over not less than two years.
(ii) The resident has participated in a minimum of 50 hours continuing education and/or course
work related to emergency or critical care such as would be sponsored by local, state, and national
veterinary or human medical organisations. This category is differentiated from (i) above in that
the above is a regularly scheduled, ongoing seminar series in a hospital setting while (ii) is a
sporadically offered veterinary conference. Monthly local veterinary association meetings would,
however, fall into this category if the subject is appropriate to this discipline. Topics should cover
a wide range of issues in emergency/critical care and cannot be accrued in less than two years. The
course work may be associated with paramedical and nursing courses related to critical care of
emergency medicine. The course work requirement cannot be fulfilled by a one-time enrolment in
a short-term continuing education program. The intent of the requirement is to ensure a continuum
of active participation in formal continuing or graduate education.
(iii). The resident has participated in a post graduate degree or fellowship program (degree not
required) in an allied biomedical science (e.g. physiology, pharmacology, cardiovascular studies,
toxicology) involving didactic courses and research experience that is associated with the discipline
of emergency/critical care. If a post graduate degree is not awarded, a description and validation of
the course work must be submitted to the FTCC, and documentation of a minimum of 50 hours of
course work must be available.
3b. Teaching Experience
The resident must document six (6) hours of lectures on emergency/critical care topics to veterinary
students, veterinary nurses, staff or veterinary audiences. Teaching experience must also include
teaching in clinical or laboratory settings for a minimum of six clinical days or six laboratories.
TRAINING IN RELATED DISCIPLINES
Refer to the Blue Book
The candidate in EMCC must spend time as stipulated by the Blue Book in any related disciplines.
EXTERNSHIPS
Refer to the Blue Book
ACTIVITY LOG CATEGORIES
1. The Activity Log shall use the following categories for both the six-month detailed Activity Log
(Appendix E-1 of the Blue Book) and the Activity Log Summary (Appendix F-2 of the Blue Book)
RICK READ TO PROVIDE CATEGORIES. EXAMPLE PROVIDED BELOW IS FROM
CANINE MEDICINE










Neurological
Haematopoietic
Endocrine
Respiratory
Cardiovascular
Alimentary
Genito-Urinary
Musculo-Skeletal
Infectious
Miscellaneous other (including dermatological, behavioural, etc)
2. The candidate must keep a log of ALL cases managed as described in the Blue Book (Appendix
E1) with the addition of a column which describes the candidate’s role in each case. For example,
triage, surgeon, internist, assistant surgeon, critical care support.
PUBLICATIONS
Refer to the Blue Book
RECOMMENDED READING LIST
The candidate is expected to research the depth and breadth of the knowledge of the discipline.
This list is intended to guide the candidate to some core references and source material. It is neither
proscriptive nor restrictive. The list is not comprehensive and is not intended as an indicator of the
content of the examination.
Texts
Murtaugh, R.J. and Kaplam, P.M. (1992) Veterinary Emergency and Critical Care Medicine,
Mosby Year Book.
Emergency Medicine and Critical Care. Proceedings 149 (1991), Postgraduate Committee in
Veterinary Science, University of Sydney.
Anaesthesia, Emergency and Critical Care. Proceedings 254 (1995), Postgraduate Committee in
Veterinary Science, University of Sydney.
Medical and Surgical Emergencies. Proceedings 333 (2000), Postgraduate Committee in
Veterinary Science, University of Sydney.
Clinical Toxicology. Proceedings 318 (1998), Postgraduate Committee in Veterinary Science,
University of Sydney.
DiBartola P (2000). Fluid Therapy in Small Animal Practice (2nd edition), WB Saunders,
Philadelphia
Marino, P.L. The ICU Book (1991), Lea and Febiger.
Nelson RW and Conto CJ (2nd ed). Small Animal Internal Medicine. Mosby – Year Book, St
Louis, 1998.
Bistner, S.I., Ford, R.B. (1995). Handbook of Veterinary Procedures and Emergency Treatment
(6th ed.), W.B. Saunders.
International VECC Proceedings (1994, 1996, 1998, 2000). Veterinary Emergency and Critical
Care Society (USA).
Plumb, D.C. (1999). Veterinary Drug Handbook, (3rd edition) Iowa State University Press.
Chernow, B. (1995). Critical Care Pharmacology (unabridged) 2nd ed.
Ganong, W.F. (1991). Review of Medical Physiology (15th ed), Lange Medical Publications.
West, J.B. (1995). Respiratory Physiology – the essentials (5th ed), Williams and Wilkins.
Guyton, A.C. (1996). Textbook of Medical Physiology (9th ed), W.B. Saunders.
Kirk, R.W., Bonagura, J.D. (1992). Current Veterinary Therapy XI. W.B. Saunders, pp68-201,
also emergency topics in systems sections, plus relevant sections of more recent issues.
Fox, P.R.et al (1999). Textbook of Canine and Feline Cardiology: Principles and Clinical Practice.
WB Saunders, Philadelphia.
Lyerly, H.K., Gaynor, J.W. (1992). The Handbook of Surgical Intensive Care (3rd ed.), Mosby
Year Book.
Slatter, D. (1995). Textbook of Small Animal Surgery (2nd ed.), W.B. Saunders.
State of the Art, Volumes 14-17 (1993-1996). Society of Critical Care Medicine, California.
Journals
The journals listed below contain original and review papers which are suitable for preparation for
the Fellowship examination.
Titles in Veterinary Emergency and Critical Care
Journal of Veterinary Emergency and Critical Care
Journal of the American Veterinary Medical Association
Compendium on Continuing Education
American Journal of Veterinary Research
Veterinary Clinics of North America
Critical Care – November 1989 19(6)
Emergency Medicine – December 1994 24(6)
Other issues on relevant topics
Journal of Veterinary Internal Medicine
Australian Veterinary Journal
British Journal of Veterinary Medicine
Veterinary Record
Titles in Human Emergency and Critical Care
Critical Care Medicine
Circulatory Shock
Journal of Trauma
British Journal of Anaesthesia
Anaesthesia and Intensive Care
CLINICAL SKILLS AND PROCEDURES CHECKLIST
This list is intended as a guide to the breadth of technical procedures which should be
accomplished by the candidate. It is not exclusive. Completion of the procedures is not indicative
of completion of Fellowship training.

Vascular
Emergency cutdown and venotomy peripheral vein
Emergency cutdown and venotomy central vein
Control of massive bleeding from major peripheral arterial injuries
Control of massive thoracic bleeding via emergency thoracotomy
Control of massive abdominal bleeding via emergency laparotomy
Placement of arterial line – femoral artery
Placement of arterial line – peripheral artery
Intraosseous catheter placement – dog/cat
Central line median femoral vein – cat
Central line median femoral vein – dog
Arterial blood sampling
Central line – jugular – cat
Central line – jugular – dog
Autotransfusion

CPCR
a.
Closed chest CPCR
intratracheal drug administration
intraosseous drug administration
sublingual drug administration – compression
simultaneous ventilation – compression
interposed abdominal compression
b.
Open chest CPCR
intracardiac drug administration
assessment of blood flow (via Doppler) during CPCR
emergency thoracotomy and closure - defibrillation
cross clamp aorta
- external
- internal

Cardiovascular/Respiratory
Echocardiogram
Pericardial effusion - dilated cardiomyopathy – dog
Valvular insufficiency - hypertrophic cardiomyopathy – cat
Stabilisation catastrophic congestive heart failure (CRI vasodilators and inotropics)
Indirect blood pressure - Doppler - oscillometric
Direct blood pressure measurement
Pericardiocentesis
ECG
Non-selective venogram or arteriogram
Cardiac pacing
Cardiac output catheter placement and monitoring (PCWP; calculation of indices)
CVP measurement
Application of principles of crystalloid fluid therapy
Application of principles of colloidal fluid support
Thoracocentesis (air, fluid)
Chest tube placement - dog - cat
Set-up underwater suction apparatus for pleural drainage
Set-up autotransfusion system for hemothorax
Tracheal foreign body retrieval by endoscopy or surgery
Set-up, management and monitoring of patient on ventilator
PEEP - CMV/Asst CMV
CPAP - IPPV, SIMV/IMV
Use of sedatives/NMJ blockers in the ventilated patient
Weaning off ventilator
Evaluation of blood gases
Nebulization and coupage
Transtracheal wash
Fine needle lung aspirate
Endotracheal wash
Slash tracheostomy
Management of tracheostomy tubes
Sternal position tracheal intubation
Dorsal position tracheal intubation
Transtracheal oxygen catheter
Nasal packing for massive haemorrhage
Bag or hood oxygen delivery
Cage oxygen delivery
Capnography (ETCO2)
Pulse oximetry
Thoracic lavage
Bronchoscopy
BAL
Nasal oxygen catheter

Abdominal/Gastrointestinal
Paracentesis
Diagnostic peritoneal lavage
Abdominal ultrasound
Control of abdominal bleeding by external counterpressure
Cystostomy tube placement for emergency urinary bladder drainage
Cystocentesis
Endoscopy – oesophagus, stomach, upper SI
Emergency abdominal exploration
intestinal anastomosis
gastrotomy
gastropexy
removal of pyometre
cystotomy
traumatic abdominal bleed control
placement of peritoneal dialysis catheter and perform dialysis
gastric lavage (toxin ingestion; GDV resuscitation)
management of open peritoneal drainage
oesophageal/gastric foreign body retrieval via endoscopy
urethral obstruction relief via catheterisation – dog
urethral obstruction relief via catheterisation – cat
indwelling urethral catheter placement – female dog - male dog
- female cat
- male cat
splenectomy
enterostomy
liver lobectomy
diaphragmatic hernia
caesarean section

Orthopaedic/Limb Trauma
spica bandage or splint to forelimb
spica bandage or splint to rear limb
wound debridement and closure with suction drain
placement of metasplint
hip luxation replacement and bandage
elbow luxation replacement and bandage
shoulder luxation replacement and bandage
placement of modified Robert Jones bandage
wound management degloving injury
placement of half cast
laceration repair
debridement and external fixator application for open fracture of long bone

Anaesthetic
Epidural anaesthesia/analgesia
Intercostal nerve blocks
Intrapleural analgesia
Intravenous regional anaesthesia
Balanced anaesthesia in the critical patient
Low flow/closed circuit anaesthesia
CRI analgesia
Transdermal analgesia
Intra-articular analgesia

Nutrition
Placement and management of NG tube
Placement and management of esophagostomy/pharyngostomy tube
Placement and management of PEG tube
Placement/management of jejunostomy tube
Calculation/formulation of TEN, PPN, TPN

Ophthalmologic
Third eyelid flap
Enucleation
Emergency tarsorrhaphy
Subconjunctival flap
Measurement of intraocular pressure
Ophthalmoscopy
Management of uveitis
Management of glaucoma

Medical Procedures
Low dose dexamethasone suppression test
ACTH stimulation test
TSG stimulation test
Urine protein:creatinine ratio
Bone marrow core biopsy
Cross-match/blood typing
Blood product collection and separation
Activated clotting time measurement, APT, APTT
Buccal mucosal bleeding time
Toe nail bleeding time
CSF tap and pressure
Blood culture collection
Bone marrow aspirate
Arthrocentesis
Cytologic evaluation of:
Blood smears
Fine needle aspirates
Abdominal/thoracic fluid

Imaging
Routine radiographic procedures and interpretation
Standing lateral radiographs
IVU/IVP
Cystourethrogram
Myelogram
Barium swallow
Upper GI Barium series
BIPS
Ultrasonographic detection of fluid in body cavities

Set-up CRI:
Dopamine
Dobutamine
Nitroprusside
Insulin
Lidocaine
Procainamide
Metoclopramide
SUGGESTED DISCUSSION TOPICS
The following list of topics is included as an indicator of the depth and breadth of subjects which
should be discussed during training either informally with the supervisor or in formal seminars. It
is not an exclusive list and is an adjunct to, not a replacement for, directly supervised clinical and
technical training.
1. Anatomy, Physiology, Pathology and Therapy of Systems Derangements
a.
Cardiovascular
Congestive heart failure (various causes), arrhythmias
Cardiac arrhythmias and conduction disturbances
Cardiac tamponade and other acute pericardial diseases
Acute valvular disorders
Acute complications or cardiomyopathies and myocarditis
Vasoactive and inotropic therapy
Current concepts of Starling’s Law and DO2/VO2 concepts
Recognition, evaluation and management of hypertension
Shock – hypovolaemic, distributive, cardiogenic, septic
ECG interpretation and application
Blood pressure monitoring
Auscultation
CVP
Cardiac output – principles and techniques
Wedge pressure measurements
Anti-arrhythmics
Inotropic agents
Vasoactive drugs
Digitalis
Oxygen balance – deliver and uptake
Primary myocardial disease
Cardiomyopathy
CHF
b. Respiratory
Haemodynamic effects caused by ventilatory assist devices
Pulmonary embolism
Acute respiratory failure
Smoke inhalation, airway burns
Aspiration or chemical pneumonitis
Chest trauma, flail chest, pneumothorax
Upper airway obstruction
Drowning
Oxygen therapy
Mechanical ventilation
Pressure and volume ventilation
Modes of ventilation
Indications for and hazards of ventilation
Criteria for weaning
Airway management
Emergency airway management
Endotracheal intubation
Tracheostomy
Nasal oxygen
Percutaneous tracheal administration of oxygen
Oxygen cages and oxygen hoods
Lung anatomy
Auscultation
Radiography
Blood gases – invasive, non-invasive measurement
Tidal volume measurement
Work of breathing
V/Q relationships
Pulmonary volumes
End tital gases – utilisation
Bronchial disease
Primary pulmonary disease
Pleural space disease
Chest wall disease and injury
Diaphragm disease and injury
Vascular disease – PTE
Pulmonary oedema
Laryngotracheal disease
Control of breathing
Ventilatory support techniques
Oxygen
IPPV
PEEP
Permissive hypercapnia
HFV-HFJV, HFO
IRV
CPAP
Weaning techniques
c.
Gastrointestinal/Hepatic
Acute pancreatitis
Upper GI bleeding
Lower GI bleeding
Megacolon
Acute perforations of the GI tract
Acute inflammatory diseases of the intestine
Abdominal trauma, blunt and penetrating
Gastric dilations – torsion
Ruptured/fractured liver
Liver – physiology – vascular, hormonal factors
Metabolism – glucose
Drug clearance mechanisms
Acid-base balance
Role in shock
Hepatic failure
Cirrhosis
Physiology – motility
Microbiology
Endothelial physiology
Vascular supply to GI tract
Prophylaxis for stress states
Sucralfate, H2 antagonists, proton pump blockers, antacids
Pancreas – physiology, response to injury
Acute and fulminant hepatic failure
d. Renal
Renal regulation of fluid balance and electrolytes
Renal failure: prerenal, renal and postrenal
Derangements secondary to alterations in osmolality and electrolytes
Sodium and potassium balance
Acute acid-base disorders and their management
Peritoneal dialysis
Oliguria
Obstructive urinary diseases
Physiology of kidney
ARF/CRF – factors and response
Oliguria
Fluid balance
Drug clearance
Role of lower trace in barrier protection
Urinary tract obstruction
Dialysis
e.
Reproductive Disorders
Eclampsia
Pyometra
Prostatic abscess
Prostatitis
Paraphimosis
Penile trauma
Orchitis/testicular torsion
Pyometra, metritis
Mastitis
Postpartum haemorrhage
f.
Metabolic/Endocrine
Endocrine Disorders
Disorders of thyroid function
Adrenal crisis and disease of adrenal function
Diabetes mellitus and insipidus
Ketoacidosis
Hypoglycaemia
Insulinoma
Disorders of calcium and magnesium balance
g.
Nutrition/alimentation
Enteral
Parenteral
Nutritional requirements in critical illness
Biochemistry of catabolism
Simple stressed starvation
Evaluation of requirements
Essential components of nutrition
AA, CHO, Lipid, Vit, Min
Role in injury and therapy
Feeding options
Enteral
Parenteral
Techniques of feeding
Oral
Forced
NG tube
NE tube
Esophagostomy
PEG tube
Jejunostomy tube
Monitoring nutrition response
Lab
Glucose
AA profile
Complications
h. Haemo-lymphatic, Infectious Diseases
Infectious diseases and management
Antibiotics, antifungals, antivirals
Anaerobic infections
Tetanus
Adverse reactions to antimicrobial agents
Haematological disorders secondary to acute illness
Acute defects in haemostasis
Thrombocytopaenia
Disseminated intravascular coagulation
Toxic coagulopathies
Immune-mediated haemolytic anaemia
i.
Neurologic
Coma
Metabolic
Traumatic
Infectious
Mass lesions
Vascular – anoxic – ischaemic
Drug ingestion
Increased intracranial pressure
Trauma
Brain
Spinal cord
Seizures
Idiopathic vestibular syndrome
Brain
Cerebral blood flow/oxygen demand
CSF dynamics
Intracranial pressure
EEG
Clinical evaluation of activity level – reflexes
Spinal cord
Mechanisms of neural transmission
Pain modulation
Peripheral NS
Neural injury
Motor end plate dz – Guillian Barre, Coonhound, Tick
Pain
Electrodiagnostics
Ocular injuries
j.
Musculoskeletal
Initial management of closed and open fractures
Spinal trauma
Crush injury
Tendon repair
k. Oculo-Otic
Management and/or repair of ocular problems anterior to the aris
Corneal ulcer
Eyelid laceration
Corneal laceration
Hyphaema
Horners syndrome
3rd Eyelid flap
Temporary tarsorrhaphy
Conjunctival flap
Acute glaucoma
Management and/or repair of acute otic conditions
Otitis media
Foreign body
l.
Integumentary
Skin trauma
Principles of wound management
Burns
m. Coagulation/Transfusion Medicine
Normal cascade
Lab testing
DIC
AT III
Procoagulant therapy
DDAVP
Aminocaproic acid
Anticoagulant therapy
Heparin
Aspirin
Coumadin
Streptokinase
TPA
Hb physiology
Transfusion practices
ACD, CPD, heparin collection
Fate of anticoagulants post-transfusion
Artificial haemoglobin solutions
n. Prehospital/Admission – Triage
Facility set up
Organisation
Emergency drugs/supplies
Primary telephone contact
Client communication
Hospital transport
Primary surgery
Secondary survey
o.
Resuscitation
Airway
Breathing
Control of acute bleeding/blood loss
Cardiovascular support
Vascular access techniques
Fluids
Emergency drugs
External support – MAST, wraps
Monitoring
Shock
Thermal support
Ischaemia-reperfusion injury
p. Primary Support Techniques
Fluids
Acid-base balance
Oxygen administration techniques and flow rates
Humidification
Cardiac support
Inotropic drugs
Vasoactive agents
Antiarrhythmics
q. Diagnostic
Haematology
Clinical chemistry – lactate, magnesium
Coagulation
Urine
Radiography/contrast procedures
Ultrasound
Echocardiography
Colour flow Doppler
Radionuclear scanning
Cardiac catheterisation
r.
Mechanisms of infection – host response
Microbiology
Gram +
Gram –
Anaerobes
Fungi
Yeasts
Viruses
Nosocomial infection
Patterns of resistance
Sites of entry
Prophylaxis
s.
Toxins
Plants
Drugs
Household chemistry
Poisons
Gaseous
Food – chocolate
Rodenticides
Decontamination procedures
t.
Pharmacology
Pharmacokinetics and factors in efficacy
Antibiotics
Antifungals
Antivirals
Antineoplastics
Anti-inflammatory
NSAID
Steroid
Lazaroids
Fluids/colloids
Inotropic agents
Cardiovascular medications
Respiratory medications
GI medications
Prokinetics
H2 antagonists
Sucralfate
Renal medications
CNS medications
Anticonvulsants
Sedatives – hypnotics
Tranquillisers
Antiepileptics
Anaesthetics
Pain medications
Neuromuscular blockers
Hormonals
Insulin
Thyroid
DOCA
Steroids
2. Management of Global Problems
There are some emergency and critical care conditions which do not fit easily into any body
systems category. The pathophysiology, diagnosis and treatment of these conditions is within the
scope of this examination. The conditions are:
Hypothermia
Disseminated intravascular coagulation
Sepsis/systemic inflammatory response syndrome
Cardiopulmonary arrest
3. Toxicities and Envenomations
Snail bait
Organophosphate toxicity
Vitamin K antagonists
Strychnine
1080
Snake
Unknowns
4. Trauma
Initial approach to the management of multisystem trauma.
5. Pharmacology and Fluid Therapy in the Emergency/ICU Patient
Candidates should be familiar with dose, indications, contraindications and drug interactions of
drugs used in the management of the emergency and critically ill patient. The following list is
intended to give a broad view of the categories of drugs that may be covered. Specific drugs have
not been listed.










Cardiovascular – inotropes, vasopressors, vasodilators, diuretics, antiarrhythmics
Respiratory – bronchodilators
Gastrointestinal/hepatic – antiemetics, antiulcer medications, gastrointestinal protectants, drugs
used in enteritis, drugs used in hepatic failure
Renal – consequences of reduced renal function upon drugs used in therapy
Metabolic/endocrine – steroids, insulin, thyroxine, other hormones
Haemo-lymphatic – blood and plasma products, antibiotics
Neurologic – steroids, mannitol, anaesthetics, analgesics
Musculoskeltetal – anti-inflammatories
Oculo-otic atropine, ocular antibiotics, ocular steroids
Fluid, acid-base and electrolytes – crystalloids (isotonic and hypertonic), colloids (natural and
synthetic), use of fluids in manipulation of metabolic acid-base derangements.
4. Assessment of the Emergency and ICU Patient
Candidates should be able to prioritise a patient’s problems based upon principles of triage.
Assessment includes usage of history, physical examination findings, clinical pathology,
radiology/ultrasound and electrocardiograms.
5. Management of Anaesthesia and Analgesia
Candidates should be familiar with the principles of anaesthesia and analgesia as they apply to the
emergency or critically ill patient. It is necessary to understand the concepts of balanced
anaesthesia, use of opioids and management of anaesthetic emergencies.
6. Principles of Monitoring
The candidate is expected to be familiar with the interpretation of various tests and monitoring
parameters including, but not limited to:
a)
Clinical Pathology
Haemogram or components thereof
Chemistry profile or components thereof
Electrolytes
Blood gases
Urine analysis
Coagulation profiles – ACT, PT, PTT, platelet counts
b)
Fluid, Acid-Base and Electrolyte Disturbances
Blood pressure – mean arterial, central venous
Fluid balance
c)
Ventilation and Oxygenation
Capnography
Pulse oximetry