U of C Critical Care Bedside Competencies Map

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1 no experience rudimentary understanding and little practical experience reasonable, but incomplete practical experience no further educational need for an independent competent execution of this medical act Medical Expert / Clinical Decision-maker: In an effort to better define the body of the knowledge and practical skills required for the training of a critical care physician, we developed a bedside competencies map for our program. This map identifies the necessary cognitive and technical bedside skills of a successfully trained University of Calgary critical care resident. This is an attempt to better define and categorize the specific objectives of the medical expert in critical care, and addresses the fact that this expertise is acquired progressively throughout two years of training. Regular individual reviews, with the Program Director of the self-assessment tool should ultimately help the resident better define his/her understanding in different subject areas and help evaluate the curriculum of our program. Key Competencies: demonstrate diagnostic and therapeutic skills for ethical and effective patient care in critical care access and apply relevant information to the critical care practice demonstrate effective consultation services with respect to the critically ill patient Specific objectives: Demonstrate basic and applied knowledge in: 1. Airway a) airway management during tracheostomy b) cricothyrotomy and indication for other urgent surgical airways c) fiberoptic intubation d) indication of tracheostomy for prolonged ventilation e) laryngeal mask ventilation f) maintenance of open airway g) nasotracheal intubation h) orotracheal intubation i) retrograde intubation j) transcricoid jet ventilation August 21, 2006 Page 1 of 5

2 2. Breathing a) application of end tidal CO2 detector post intubation b) application of pulse oxymetry c) bronchoalveolar lavage d) fiberoptic laryngoscopy in intubated patient with airway obstruction e) fiberoptic laryngoscopy in non-intubated patient with airway obstruction f) hyperbaric oxygenation g) insertion of tracheostomy tube h) intubated fiberoptic bronchoscopy i) mechanical ventilation indications non-invasive ventilation pressure and volume ventilators PEEP CPAP HFV IRV PSV PCV APRV IMV JET ventilation independent lung ventilation prone ventilation tracheal insuflation high frequency oscillation lung recruitment therapy extrapulmonary effects barotrauma, volutrauma, complications extracorporeal membrane oxygenation permissive hypercapnea liquid ventilation j) NO administration k) non-intubated fiberoptic bronchoscopy l) oximetric pulmonary artery catheter m) protected brush specimen sampling n) pulmonary monitoring airway pressure (pressure volume curve ) August 21, 2006 Page 2 of 5

3 intrathoracic pressure (oesophageal pressure measurement) compliance, elastance, resistance capnography weaning indices and strategies o) special gas admixture administration (heliox ) p) thoracocentesis q) thoracostomy tubes r) ventilation by bag and mask 3. Circulation a) application and maintenance of intra-aortic devices b) arterial lines c) cardiac output measurements and other derived calculation from pulmonary artery catheter d) cardiac overdrive pacing e) central venous lines f) defibrillation g) ECG interpretation h) elective cardioversion i) level I infuser j) pericardiocentesis k) prevention and management of air embolism l) pulmonary artery catheter m) temporary atrial pacemaker n) temporary transcutaneous pacemaker o) utilization, zeroing, calibration of transducers 4. CNS a) application of controlled hypothermia b) application of EEG monitoring / cerebral doppler c) CSF drainage for raised ICP d) declaration of brain death e) jugular bulb oximetry f) lumbar puncture g) supervision and insertion of ICP monitoring h) therapy aimed at maintenance of cerebral perfusion pressure August 21, 2006 Page 3 of 5

4 5. Renal a) bladder catheterization b) continuous renal replacement therapy CAVH CAVHD SCUF CVVH CVVHD CVVHDF circuit anticoagulation including citrate protocol indications, complications non-renal use c) management of CAPD in the ICU d) indication of acute intermittent hemodialysis, use of diuretics in the ICU e) vascular access for acute dialysis 6. GI / GU a) duodenal intubation for feeding purpose b) gastric tonometry c) gastro oesophageal balloon tamponade d) intra abdominal pressure monitoring e) naso / orogastric tube placement f) peritoneal tap 7. Hematology a) anticoagulant, fibrinolytic therapy b) autotransfusion c) fibrinolytic therapy d) management of massive transfusions e) supervision of plasmapheresis done in ICU f) thromboembolic disease prophylaxis g) utilization of blood component therapy h) utilization of hemoglobin solutions August 21, 2006 Page 4 of 5

5 8. Nutrition a) enteral feeding b) parenteral feeding 9. Transport / Other a) organization and supervision of inter-city transfers b) organization of out of town transfers c) use of special beds Resident Signature: Date: August 21, 2006 Page 5 of 5

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