MAP5101 - Advanced critical care skills

Upon successful completion of this unit, students should be able to:

Extracorporeal Support

1. Critically evaluate techniques for the measurement of circulatory variables in the critically ill.
2. Explain the physical and physiological principles of extracorporeal support as they relate to temporary pacing (transcutaneous, transvenous and epicardial), IABP, ECMO and renal replacement therapy; and outline the indications, contraindications and most common complications of using each technique.
3. Outline the principles of haemodialysis and haemofiltration and how the combination of these strategies can be used in the management of critically ill patients.
4. Discuss the latest techniques to optimise filter life including access, dosing, dilution strategies and anticoagulation as they relate to RRT.
5. Explain the different modes and configurations of ECMO used for respiratory and cardiac failure respectively and outline the optimal catheter types and positions associated with each of these configurations.
6. Critically evaluate the indications and contraindications to ECMO and how these relate to the timing of institution of ECMO support.

Transthoracic Echocardiography (TTE), Transoesophageal Echocardiography (TOE), Critical Care Ultrasound

===Transthoracic echocardiography===

1. Understand the basic physic principles applicable to ultrasound.
2. Understand standard TTE views and how they are acquired.
3. Understand advanced Doppler techniques (RVSP and cardiac output).
4. Be able to perform and report a level one echo with predominantly qualitative reporting of pathology in a systematic fashion.

===Transoesophageal echocardiography===

1. Understand how to acquire the standard 28 ASE views in a simulated model.
2. Have an in-depth understanding of he 3D cardiac anatomy.
3. Understand the indications for TOE in ICU, cardiac surgery and cardiology practice.

===Critical Care Ultrasound (for all 4 ultrasound topics performed)===

1. Understand the different probe types, selection and their utility across different ultrasounds performed.
2. Understand the appropriate anatomy for the relevant ultrasound procedures.
3. Understand how to interpret abnormal pathology and the clinical implications.
4. Be able to accurately perform a complete ultrasound to evaluate for DVT screening, Vascular access, eFAST, Lung ultrasound and Pleural ultrasound.

Airway, Bronchoscopy and Ventilation

1. Demonstrate the technical skills required for airway management of critically ill patients.
2. Display the teamwork and decision-making skills required for airway management of critically ill patients.
3. Discuss important issues in weaning from mechanical ventilation (this applies to 2015 only and will vary according to the theme of The Alfred ICU Mechancial Ventilation Conference).
4. Apply the interpretation of ventilator waveforms to the management of critically patients.
5. Describe the role of bronchoscopy in ICU, bronchoscopic anatomy and relevant equipment.
6. Demonstrate the practical skills required to perform bronchoscopy and bronchoscopic procedures in the management of critically ill patients.