Intensive Care Fundamentals 2024

Outcomes 1: The deteriorating patient

• Identify an acutely ill or deteriorating patient (in a simulated setting)
• Identify life-threatening conditions in an effective and timely fashion using the ABCDE approach (in a simulated setting)
• Stabilise and initiate treatment for a critically ill patient (in a simulated setting)
• Discuss the risks and possible pitfalls of transporting a critically ill patient
• Recognise and manage circulatory arrest and peri-arrest states (in a simulated setting)
• Describe the patient at risk of difficult intubation

Outcomes 2: Ward round

• Demonstrate a routine daily reassessment of a patient in a structured manner (in a simulated setting)
• Effectively prescribe venous thromboembolic disease and stress ulcers prophylaxis.

Outcomes 3: Organ support

3a: Acute respiratory failure

• Describe the indications and modalities of oxygen therapy, non-invasive ventilation methods, and indications for intubation and invasive mechanical ventilation
• Apply basic physiological principles of mechanical ventilation - volumes, pressures, compliance etc. in the management of the most common lung pathologies using basic modes of ventilation (in a simulated setting)
• Demonstrate the ability to initially set a ventilator and adapt ventilatory settings for patients with the most common types of ventilation disorders, including obstructive pulmonary disease and ARDS (in a simulated setting/app)
• Select an adequate PEEP based on physiological values (in a simulated setting/app)
• Identify the most common types of ventilator interference (in a simulated setting/app)
• List the most common cause of sudden hypoxia in a patient with a tracheostomy
• Discuss the managment of the acutely hypoxic patient on mechanical ventilation in ICU
• Describe the principles of weaning from mechanical ventilation, readiness testing and the risk factors for weaning failure

3b: Shock and Haemodynamic monitoring

• Describe basic cardiovascular physiology and its monitoring in the context of the most common pathologies in ICU, including cardiac output and its measurement, left heart failure, and right heart failure
• Demonstrate assessment of fluid responsiveness in the simulated haemodynamically unstable patient/case
• Discuss the indications and use of vasopressor therapy
• Describe the different aetiologies of shock, recognise the role of POCUS to help assess the causes of haemodynamic instability

3c: Sepsis and septic shock

• discuss the warning signs of life-threatening infection
• discuss the one-hour bundle of treatment of patients with sepsis
• Describe the most common ICU acquired infections and propose an effective initial antibiotic treatment
• Identify the need for urgent source control in sepsis where appropriate in a simulated setting or case
• Describe the basics of antibiotic stewardship

3d: Metabolic derangements

• Interpret arterial blood gases
• Describe a treatment plan for patients with life-threatening electrolyte and metabolic disturbances
• Propose the appropriate management for patients with the most common metabolic disorders, especially hyperkalaemia and hypernatraemia
• Discuss the importace of fluid choice and balance in the critically ill patient

3e: Renal failure

• Recognise indications for urgent renal replacement therapy (in a simulated patient/case)
• Describe common Renal Replacement Therapy (RRT) modes and compare haemodialysis, haemofiltration and haemodiafiltration

3f: Nutrition

• Discuss the benefits and risks of enteral and parenteral nutrition

3g: Treatment and prevention of delirium, sedation and analgesia

• Discuss the physical and psychosocial needs of hospitalised patients with regards to the prevention of delirium
• Describe signs of hypo- and hyperactive delirium and treatment options
• Safely prescribe sedation and analgesia in a simulated ICU setting or case, including adequate use of sedation holds

Outcomes 4: Specific pathologies in the intensive care unit

4a: Trauma and Surgery

• Discuss suitable options for perioperative pain management
• Apply the principles of safe blood transfusion to a simulated patient with life-threatening haemorrhage / trauma
• Diagnose and propose a treatment plan for the common coagulopathies in a simulated patient or case
• Discuss the management of haemorrhage in a patient who is receiving an anticoagulant/antiplatelet agent

4b: Neurological emergencies and basics of neurointensive care

• Describe the pathophysiology of intracranial hypertension and its operative and non-operative management
• Describe a treatment plan for patients with various neurological injuries (e.g.,Traumatic Brain Injury [TBI] and stroke)
• Explain the meaning of neuroprotective measures in patients with brain injury
• Discuss the immediate actions needed when a patient is showing signs of coning
• Discuss the initial management of patients with seizures and/or status epilepticus
• Plan neuroprotective strategies following cardiac arrest in a simulated patient or case
• Describe the principles of post-resuscitation care prognostic assessment post-CPR

4c: Medical emergencies

• Recognise and effectively treat life-threatening brady- and tachyarrhytmias in a simulated setting

Outcomes 5: Non-technical aspects of intensive care

5a: Ethics of intensive care, end-of-life aspects

• Explain the limitations of intensive care, and the principles of withholding and withdrawing treatment, inclulding potential organ donation
• Describe a management and treatment plan for the patient at the end of life including symptom relief therapy

5b: Crisis resource management and communication in crisis

• Discuss the principles of communication in crisis and crisis resource management (leadership, membership, situational awareness) and relate them to their own experience and professional context
• Communicate in a professional but effective and assertive manner in a simulated emergency
• Demonstrate a succinct and structured handover in a simulated setting

Outcomes 6: Equipment

• Troubleshoot common issues with equipment: monitoring, arterial lines, central venous catheters, and chest drain