Emergency Medicine IV

Internal Medicine

Course Master(s):

Prof. Dr. Katja-Nicole Adamik, Dipl. ACVECC/ECVECC (CH)

Instructor(s):

Dr. Ariane Schweighauser, Dipl. ACVIM, Dipl. ECVIM-CA

Important notes and requirements

Completion of Emergency Medicine I or the previous Emergency & Critical Care I course is required before attending Emergency Medicine II, III, or IV.

Course Overview

This module provides advanced postgraduate training in the recognition, diagnosis, stabilization, and management of endocrine, renal, hematologic, toxicologic, and selected dermatologic emergencies in small animal patients. The course emphasizes evidence-based emergency medicine, electrolyte and acid–base disturbances, emergency stabilization, and clinical decision-making in complex internal medicine emergencies.

Indicative Content

Endocrine Emergencies

• Addisonian crisis pathophysiology, diagnosis and treatment
• Diabetic ketoacidosis pathophysiology, diagnosis, stabilization and treatment including different protocols
• Approach to hyperglycemic crisis
• Hypoglycemia including insulinoma
• Calcium disorders emergency presentations
• Acute pancreatitis

Renal and Urinary Emergencies

• Renal physiology and diagnostic approach to the patient with azotemia
• Obstructive feline lower urinary tract disease including stabilization, catheterization and post-catheterization management
• Ureteral obstruction -causes and case-based treatment decisions
• Acute kidney injury identification and stabilization goals
• Management Acute-on-chronic kidney injury

Hematologic and Coagulation Emergencies

• Anemia definition and diagnostic approach
• Immune-mediated hemolytic anemia diagnosis and treatment
• Immune-mediated thrombocytopenia diagnosis and treatment
• Review of hemostasis
• Coagulation abnormalities in small animal patients

Toxicologic Emergencies

• Principles of intoxication management
• Decontamination techniques
• Lipid therapy
• Neurological intoxications
• Food poisoning
• Human medication toxicities

Dermatologic emergencies

Learning Outcomes

Upon successful completion of this module, participants will be able to:

Knowledge and Understanding

1. Describe the pathophysiology underlying endocrine, renal, hematologic, coagulation, and toxicologic emergencies in small animal patients.
2. Outline the key diagnostic and stabilisation priorities in patients presenting with metabolic, renal, hematologic, and toxicologic disorders.
3. Define and classify laboratory findings, electrolyte abnormalities, coagulation profiles, and acid–base disturbances relevant to emergency internal medicine.
4. Explain the principles of emergency management for diabetic ketoacidosis, Addisonian crisis, acute kidney injury, urinary obstruction, and intoxications.
5. Recall the current evidence-based therapeutic approaches to emergency fluid therapy, electrolyte correction, decontamination, and transfusion-related interventions.
6. Name the clinical signs, diagnostic criteria, and underlying pathophysiology of Addisonian crisis and diabetic ketoacidosis in small animal patients.
7. List the common toxins encountered in small animal emergency medicine and outline the respective mechanisms of toxicity and general principles of decontamination.

Clinical and Technical Skills

1. Perform systematic emergency assessment and stabilization of patients with endocrine, renal, hematologic, and toxicologic emergencies.
2. Formulate evidence-based treatment plans for patients with diabetic ketoacidosis, Addisonian crisis, acute kidney injury, and urinary tract obstruction.
3. Interpret emergency laboratory and coagulation findings to support clinical decision-making and monitoring.
4. Apply emergency management principles for intoxications including decontamination strategies and lipid therapy.
5. Develop monitoring and reassessment protocols for critically ill internal medicine emergency patients.
6. Assess hematological and coagulation abnormalities in immune-mediated disease and recommend appropriate transfusion and immunosuppressive treatment strategies.
7. Diagnose acute kidney injury and acute-on-chronic kidney disease using clinical and laboratory findings and recommend evidence-based fluid and supportive therapy protocols.

Professional Competencies and Clinical Decision-Making

1. Prioritize emergency interventions using structured clinical reasoning in complex internal medicine emergencies.
2. Integrate clinical examination findings with laboratory and diagnostic data to guide dynamic emergency treatment planning.
3. Communicate effectively with veterinary team members regarding stabilization priorities, monitoring, and ongoing emergency management.
4. Apply principles of patient safety, professional responsibility, and evidence-based medicine during emergency interventions.
5. Critically evaluate emergency case outcomes and identify opportunities for quality improvement and continued professional development.
6. Design and oversee insulin therapy and fluid correction protocols for DKA and hyperosmolar patients, assuming autonomous responsibility for ongoing reassessment and dose adjustment.
7. Coordinate the triage and sequential management of multiple concurrent internal medicine emergencies, delegating tasks appropriately and evaluating clinical progress at each reassessment point.

Learning and Teaching Strategy

The module combines:

• Specialist-led online lectures
• Interactive virtual case discussions using vevox polling app
• Clinical reasoning exercises
• Evidence-based emergency medicine discussions
• Small-group interactive learning sessions

The course emphasizes integration of theoretical knowledge with practical emergency clinical reasoning and specialist-level decision-making.

Course Program (Subject to change)