THE TAMILNADU DR. MGR MEDICAL UNIVERSITY

Transcription

1 THE TAMILNADU DR. MGR MEDICAL UNIVERSITY CURRICULUM FOR FELLOWSHIP IN CRITICAL CARE AND INTENSIVE CARE MEDICINE AIM: The need for the arficial airway, cardiopulmonary resuscitaon and mechanical venlatory support are on the increase in the recent years. Such emergencies are well recognised by the anaesthesiologist and they are the right intensivist for handling of such crically ill paents. They provide the expert special skills in the management of both medical and peri/postoperave intensive care. Hence this course has been designed to train candidates in the principles and pracse of intensive care and art of arficial venlaon by the anaesthesiologist Course: Crical Care/Intensive Care Eligibility: MBBS/PG Diploma/ PG Degree Course duraon : 1 year Timings: 8 a.m 3 p.m ; 24 hours duty No. Of students per year: 4 20 students Mode of teaching: Medical colleges affiliated to the university/ Private hospital TEACHING FACULTY: Designaon No.of post required Minimum qualificaon Course Director or Professor 1 MD ( ANESTHESIA) Associate professor / Assistant professor 1 MD (ANESTHESIA)

2 Assistant Professor 2 MD(ANESTHESIA) ADMINISTRATIVE STAFF : Administrave officer Clerk Staff nurse Computer operator Accountant Librarian Assistant librarian LABORATORY SKILL LABS CLASS ROOMS/DEMO ROOMS Syllabus: 1. Basic sciences: Anatomy, Physiology, Pharmacology, Biochemistry. 2. General Medicine 3. Cardiology 4. Crical care Anesthesia 5. Radiology 6. Blood bank 7. Mechanical venlaon and management of paent on venlator 8. Obstetrics 9. Paediatrics

3 10. Burns and management 11. Renal replacement therapy 12. Basics of monitoring in ICU 13. Interpretaons of invesgaons Detailed syllabus: ANATOMY: Respiratory system: Larynx, tracheobronchial tree, lungs CVS: coronary circulaon, Chambers of heart, Valves, Anatomy of conducon pathway CNS: Brain, CSF, NMJ, Cranial nerves, Sympathec and Parasympathec nervous system. Surface anatomy: Anterior triangle of neck, cubital fossa, femoral triangle, Radial artery, all large veins. Kidney Liver Pelvis and pelvic organs PHYSIOLOGY: Respiratory physiology Cardiovascular physiology Neurophysiology Physiology of pain Pain pathway Coagulaon pathway Acid base status

4 Fluid balance Electrolyte balance Autonomic nervous system Renal physiology Hepac physiology Endocrine physiology PHARMACOLOGY: Pharmacokinecs and pharmacodynamics of all drugs related to clinical anesthesia and Emergency life saving drugs BIOCHEMISTRY: Electrolytes Acid base Balannce GENERAL MEDICINE AND CARDIOLOGY: Respiratory disorders Cardiovascular disorders Acute MI,Cardiac arrhythmias and conducon abnormalies Aorc dissecon Acute heart failure Hypertensive emergencies Endocrinology: Diabetes and thyroid disorders Infecous diseases: Nosocomial infecons, cellulis, fungal infecons, infecons due to immunocompromised state

5 Crical care anesthesia Concept of ICU care Criteria for admission and discharge from ICU Recognion of warning signs of crical illness Introducon to various types of shock and its management Recognion of life threatening changes and physical parameters Management of acute MI Recognion respiratory failure and management Acute lung injury and ARDS Management of Status asthmacus Treatment algorithms for common medical emergencies Treatment algorithms for poisoning Fluid resuscitaon technique Treatment strategies for abnormal electrolyte, fluid and acid balance Indicaons for venlator support, basics of venlatory sengs Management of paent on venlator Weaning from venlator Nutrional support in ICU: Enteral and Parenteral Recognion of arrhythmias and management Management of Diabec ketoacidosis Recognion of AKI Renal Replacement therapy Management of respiratory and metabolic acid base disorders

6 Maintenance of cadaver and brain dead. Principles of blood and blood product administraon. Pain management and sedaon in ICU Classificaon of anbiocs and mechanism of acon Anbioc sensivity and applicaon Indicaons and principles of Bronchoscopy Management of mass causality End of life care management Organ donaon and medico legal aspects OBSTETRICS: Common obstetric emergencies Management of eclampsia and Haemorrhage SKILLS TO BE OBTAINED 1. BLS 2. ACLS 3. ATLS 4. Vascular Cannulaon: venous and arterial 5. Intubaon skill 6. Biomedical instrumentaon 7. Ultra sound for intensivist MONITORING : Clinical assesment of vital organ funcon Hemodynamic monitoring with invasive catheters

7 Bedside respiratory monitoring : Evaluaon of compliance, airway resistance and respiratory muscle strength Monitoring of cardiac arrhythmias and ischemia /infarcon with connuous ECG Bedside monitoring of gas exchange, including blood gas analysis and noninvasive monitoring of CO2 exchange Simple assessment of metabolic and renal funcon, including acid base physiology, serum and urine electrolytes Neurological assessment through physical exam and interpretaon of intra cranial pressure RESPONSIBILITIES: Maintenance of Logbook Maintenance of venlatory charts Order and priorize appropriate invesgaons Idenfy abnormalies requiring urgent intervenon Document invesgaons undertaken, results and acon taken Understand non verbal communicaon with crically paents Principles of delivering bad news to paents and families THEORY CLASSES: 2 Hours per day, 2hrsX5days per week TEACHING AND TRAINING METHODOLOGY: Training period requires in service residency programme

8 Training in airway management, ICU care, skills in invasive monitoring techniques and analysis of complex invesgaons should be the major component of training methodology. Management of brain dead paents for organ retrieval Should conduct seminars, symposiums and journal clubs for the PG students. Should organise CME and workshops Should conduct internal medical audit every month To maintain Logbook of the work assigned to them Desirable publicaons of research papers in e journal, naonal or internaonal journals. Posngs in various units: Zero Delay casuality ( surgical and medical) 1 month ICCU 1.5 months PACU Radiology Blood Bank CT ICU (adult and paediatric) Burns ICU Neonatal and Paediatric ICU Obstetric ICU IMCU 2 months 15days 15 days 1 month 1 month 1 month 1 month 2months Pain clinic 15 days Assessment: Periodic internal assessment( 2 per year), both in theory and clinical should be made for every candidate

9 Internal assessment will be made on day to day work of the trainee, which involves postoperave paent care, ICU management, emergency service, hands on training, bed side presentaons, log book maintenance, technique and research. EXIT EXAMINATION: This should be done at the end of 1 year of training. Consists of clinical examinaon and viva voice One long case and two short cases will be given to each candidate and clinical discussion would last for minutes for long case, minutes for short case. The candidate should also be given ECG, X RAYS, ABG reports to interpret. Various equipment used in OT and ICU, Catheters for invasive monitoring, drug, fluid therapy to be interpreted and discussed. Log book will be assessed. BLS and CPCR skills. Board of examiners: Two internal examiners ( one is director/hod and other as Prof. of intensive care/ Anaesthesiology) and one external examiner or as per university rules The director / HOD should be the convenor for the examinaon. SCHEME OF EXAMINATION ( END OF COURSE) Sl Subje Internal Theory Clinical Viva

10 N o ct 1 Basic scien ces appli ed to cric al care 2 Cric al care mana geme nt assessme nt Max Min Max Min Max Min Max Min Reference Books: 1. ICU by Paul Marino 2. Washington manual of crical care 3. Respiratory support in ICU 4. Recent trends in anesthesia and crical care 5. Textbook of crical care by Shoemaker 6. Procedures and monitoring of crically ill paents by Shoemaker 7. Principles and pracse of Internal medicine by Harrison 8. Clinical applicaon f mechanical venlaon by David W Chang

11 DR.KUMUDHA LINGARAJ PROFESSOR OF ANESTHESIA STANLEY MEDICAL COLLEGE AND HOSPITAL