ICU
To meet the rotational
goals and objectives, the anesthesia resident will be expected to actively
participate in the ICU team duties including call responsibilities, ward
and emergency consultations, and care of the ICU patients. The resident
will be expected to assume a progressive increase in patient care
responsibilities as they become more senior residents, such that a PGY4
and PGY5 resident should be assuming an active teaching role for more
junior residents and function as a resource and consultative role for
other residents.
The rotational goals
and objectives listed below define the minimum core knowledge content that
should be reviewed during the four 4-week block adult ICU rotations. The
clinical exposure to each of the knowledge content areas will vary and is
not expected to be an-inclusive.
Knowledge:
1.
To gain an appreciation of the pathophysiology, differential
diagnosis, investigation and management of:
Cardiac:
Shock states including: hypovolemic,
cardiogenic, distributive and obstructive shock
Chest pain syndromes including myocardial
ischemia, infarction, myocarditis and pericarditis
Hypertensive crisis
Cardiac arrhythmias
Right and left sided heart failure
Pulmonary:
Community and hospital acquired pulmonary
infections
Obstructive airway disease and status
asthmaticus
Respiratory insufficiency / failure
ARDS
Pulmonary trauma
Smoke inhalation and burns
Pulmonary aspiration
Renal:
Acute renal insufficiency and failure
Acute disturbances in electrolyte and acid base
status
Neurology:
Altered level of consciousness and comatose
states
Seizures and status epilepticus
Cerebral aneurysm
Raised ICP
Cerebral trauma
Intracerebral bleed
Spinal trauma, acute quadra / paraplegia
Declaration of brain death
Gastrointestinal:
Pancreatitis
UGI and LGI bleeding
GI perforation and shock
Hepatic insufficiency – fulminant hepatic
failure
Acute poisoning / intoxication
Mesenteric ischemia / infarction
Toxic megacolon
Intra-abdominal compartment syndrome
Hematologic:
Anemia
Thrombocytopenia
DIC
Primary fibrinolysis
Anticoagulant therapy
Endocrine:
SIADH
Diabetes Insipidus
Diabetes ketoacidosis, coma
Thyroid storm
Myxedema
Adrenal insufficiency
Infectious/immune:
Septic critically ill patient
Febrile neutropenic patient
Patient with Fever of Unknown Origin
Iatrogenic nosocomial infections in the ICU
Trauma:
Upper and lower airway trauma
Penetrating and non-penetrating chest and
abdominal trauma
Orthopedic trauma
Genitourinary trauma
Burn patients
1.
To enhance the residents knowledge base with respect to the
indications for, and rationale use of the following drugs in the critical
care setting:
ACE inhibitors
Anti-arrhythmics
Antibiotics
Beta blockers
Diuretics
Vasodilators
Vasopressors
Steroids
Drugs used to treat myocardial ischemia
Drugs used to decrease gastric acid or protect
the gastric mucosa
To gain an understanding of the principles and
rationale management of:
Oxygen therapy
Non-invasive mechanical ventilatory support
Invasive mechanical ventilatory support
(including HFPPV)
Weaning from ventilatory support
Hemodialysis, peritoneal dialysis, CVVH,
ultrafiltration
Nutritional support of the critically ill
patient (including enteral and perenteral support / indications /
complications)
2.
To develop an appreciation of the indications for, limitations of,
and complications of:
ECG and ST segment monitoring
X-ray, CT and MRI evaluation of the critically
ill patient
Invasive arterial blood pressure monitoring
Central venous, pulmonary artery, and cardiac
performance monitoring
End-tidal CO2 monitoring
Arterial and venous blood gas analysis
EEG and ICP monitoring
Skills:
1.
To increase proficiency in the performance of the following
procedural skills:
Peripheral venous access
Nasogastric tube placement
Arterial line placement (aseptic technique)
Central line and PA catheter placement (aseptic
technique)
Endotracheal intubation
Mechanical ventilation
Fiberoptic intubation
Fiberoptic bronchoscopic examination
2.
The resident should review the technique for the following optional
skills for which they may or may not have an opportunity to perform during
their ICU rotation:
Hemodialysis catheter insertion
Chest tube insertion
Pericardiocentesis
Cricothyroidotomy
Transcutaneous pacemaker application and use
Temporary transvenous pacemaker insertion and
use
Attitude and Communication skills:
The
resident is expected to demonstrate effective communication skills by:
1.
Providing a clear concise summary of the critically ill patients’
problems and proposed management plan both verbally and in a written
format.
2.
Communicate clearly with other health care workers and students,
explaining the rationale for the proposed care of a patient and the
continuation or withdrawal of treatment.
3.
Demonstrate a commitment to patient care, even if this entails
personal sacrifice.
4.
Effectively communicate bad news to family members in a
compassionate, professional and caring manner.
5.
Participate in family meetings to discuss ethical management issues
with other members of the nursing, family and health care team.
6.
Honour patient confidentiality and refrain from case discussion in
public forums.
To
resident is expected to gain experience and develop communication skills
specifically by:
1.
Answering questions and keeping the family members abreast of the
patients progress in a caring, reassuring and compassionate manner.
2.
Obtaining informed consent for invasive procedures when applicable.
3.
Obtaining consent for organ donation when applicable.
4.
Participating in teaching rounds.
5.
Participate in teaching activities and supervise other residents
and medical students.
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