Emergency and Critical Care makes up 7% of the VTNE — around 14 questions. Topics include triage, CPR using the RECOVER guidelines, shock recognition and fluid resuscitation, toxicology management, and critical patient monitoring. The VTNE is particularly focused on the vet tech's role during emergency response and the ability to prioritize care.
7% of the VTNE — approximately 14 questions. Allocate roughly 7% of your total study hours here to mirror the exam's weighting.
Memorize the RECOVER BLS algorithm cold: airway → breathing → compressions (100–120/min, 30:2), rotate compressors every 2 minutes. Then know the top 5 toxins seen in small animals (grapes/raisins, xylitol, NSAIDs, permethrin in cats, acetaminophen in cats) and their antidotes or management. These two areas alone account for the majority of ECC VTNE questions.
Triage & Emergency Assessment
Primary survey (ABCs): Airway (patent, obstructed), Breathing (rate, effort, sounds), Circulation (HR, pulse quality, CRT, mucous membrane color). Triage categories: immediate (life-threatening, treat now), urgent (stable but needs prompt care), non-urgent (can wait). Signs of cardiovascular collapse: pale/white MMs, CRT > 2 sec, weak/absent pulses, altered mentation.
CPR & RECOVER Guidelines
RECOVER (Reassessment Campaign on Veterinary Resuscitation): evidence-based CPR guidelines. Confirm cardiac arrest (no pulse AND no breathing). Begin BLS immediately. Compression depth: 1/3 to 1/2 of chest width. Rate: 100–120/min. Allow full chest recoil between compressions. Do not pause > 10 seconds.
BLS & ALS
BLS (Basic Life Support): chest compressions + ventilation. Compress 30× then 2 breaths (30:2 ratio) OR continuous compressions with async ventilation at 10 breaths/min (if ET tube placed). ALS (Advanced Life Support): IV access, vasopressors (epinephrine 0.01 mg/kg IV every 3–5 min), defibrillation for VF/pulseless VT (4 J/kg biphasic).
Shock Recognition & Types
Hypovolemic: blood/fluid loss — pale MMs, tachycardia, weak pulses, hemoconcentration. Distributive (septic): warm shock early (bounding pulses, hyperemia) → cold shock late (vasoconstiction). Cardiogenic: heart failure — pulmonary crackles, venous distension. Obstructive: GDV, pericardial tamponade. All require immediate triage and intervention.
Fluid Resuscitation & IV Access
Establish IV access immediately (cephalic, saphenous, jugular, or intraosseous if vascular access fails). Shock bolus: dogs 20 mL/kg crystalloid over 15 min; reassess; repeat up to 90 mL/kg total. Cats: 10 mL/kg bolus; maximum 60 mL/kg. Colloids (hetastarch): 5 mL/kg bolus, slower rate. Reassess after each bolus — avoid fluid overload.
Vascular Access
Intraosseous (IO) access: used when IV access impossible (neonates, collapsed patients, birds). Sites: tibial crest, femoral trochanteric fossa, humeral head. Flush with heparinized saline; all IV fluids and drugs can be given IO. Abandon IO once IV access established. Document insertion site and time.
Critical-Patient Monitoring
Continuous ECG, pulse oximetry (SpO2), indirect BP (Doppler or oscillometric every 5–15 min), temperature, urine output (Foley catheter: goal 1–2 mL/kg/hr), pain score. Mental status check every hour. Blood gases if available. Alert veterinarian to: MAP < 60, SpO2 < 90, urine output < 0.5 mL/kg/hr, temperature < 36 °C.
Toxicology & Poison Management
Grapes/raisins/currants: acute renal failure in dogs; decontaminate (emesis), activated charcoal, IV fluids, renal monitoring. Xylitol: hypoglycemia (acute), hepatotoxicity (dogs); emesis if recent ingestion, dextrose supplementation. Permethrin: severe toxicity in cats — tremors, seizures; bath, methocarbamol for muscle tremors. Acetaminophen: methemoglobinemia in cats — N-acetylcysteine antidote.
Trauma Stabilization
Primary survey, then secondary survey for injuries. Spinal precautions for trauma patients until cleared. Pneumothorax: dyspnea + tracheal deviation + absent lung sounds → thoracocentesis. Hemothorax: blood in pleural space. Rib fractures + lung contusion: common in HBC (hit by car). Oxygen therapy for all trauma patients.
Hemorrhage Control
Direct pressure first. Pressure bandage for limb wounds. Tourniquet for life-threatening limb hemorrhage only (document time applied; max 2 hours). Autologous blood transfusion (autotransfusion) for body cavity hemorrhage. Blood product types: pRBC (packed red blood cells), FFP (fresh frozen plasma for coagulation support), whole blood.
Respiratory Distress & Airway
Assess: respiratory rate, effort (paradoxical breathing, open-mouth breathing in cats = severe), auscultation. Brachycephalic patients prone to upper airway obstruction — monitor closely. Tension pneumothorax: trachea deviation, severe dyspnea, absent breath sounds, hemodynamic compromise — needle thoracocentesis immediately. Pleural effusion: thoracocentesis for diagnosis and treatment.
Emergency Nursing Care
Anticipate next steps: set up oxygen, prepare crash cart drugs (epinephrine, atropine, lidocaine, dextrose), have ET tube sizes ready. Keep a crash cart checklist updated. Warm patients (avoid hyperthermia). Document every intervention with time. Communicate findings to veterinarian concisely using SBAR (Situation, Background, Assessment, Recommendation).
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Frequently Asked Questions
What are the RECOVER CPR guidelines tested on the VTNE?
RECOVER guidelines: confirm cardiac arrest (no pulse, no breathing). Begin BLS: 100–120 chest compressions per minute, depth 1/3 to 1/2 of chest, full recoil. Ventilate 30:2 (30 compressions, 2 breaths) OR continuous compressions at 100/min with async breaths at 10/min via ET tube. Rotate compressors every 2 minutes. No pause > 10 seconds.
What are the most common toxins tested on the VTNE?
High-yield toxins: grapes/raisins (AKI in dogs), xylitol (hypoglycemia and hepatotoxicity in dogs), permethrin (neurologic toxicity in cats), acetaminophen (methemoglobinemia in cats, hepatotoxicity), NSAIDs overdose (GI and renal). Know each toxin's mechanism, target species, and management.
What is the shock fluid rate for dogs on the VTNE?
Initial crystalloid bolus for dogs in shock: 20 mL/kg IV over 10–15 minutes. Reassess perfusion parameters after each bolus. Continue in increments up to a maximum of 90 mL/kg/hr (the blood volume). Cats: initial bolus 10 mL/kg, maximum 60 mL/kg.
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