Critical Care Clerkship Goals and ObjectivesGoalsUpon completion of the critical care clerkship, students should recognize that the skill set required for exemplary critical care (illustrated by the mnemonic PROPER CARE) involves the ability to Prioritize activities (A,B,C,D,E), procedures and tests in critically ill patients understanding the tempo required for resuscitation and stabilization and the relationship between treatment intensity and clinical benefit Recognize common clinical patterns and how they indicate impending cardiopulmonary arrest, circulatory shock, respiratory failure and need for resuscitation Organize the data set (link the information in a cohesive manner) to form a working hypothesis concerning the mechanisms responsible for critical illness so that diagnostic or therapeutic interventions target that possibility Protect patients; provide prophylaxis against nosocomial infection, venous thromboembolism and gastrointestinal bleeding; protect patients’ rights, privacy, dignity and respect Evaluate ethical aspects of care and end of life issues; examine whether therapeutic goals should change from "cure to comfort" Review the literature and acquire new information from appropriate sources; realize that each case provides opportunities to affirm evidenced-based practices, the potential for research and the importance of life-long learning Communicate effectively with patients, families and healthcare providers, comprehending the value of teamwork (pharmacy, nursing, respiratory therapy), compassion and clarity in the ICU setting Assess illness severity and appropriate patient disposition Recognize personal limitations and request appropriate consultations Evaluate a patient’s response to critical care interventions to generate new hypotheses and diagnostic/treatment strategies ObjectivesUpon completion of the critical care clerkship, students should be able to:
Employ fundamental knowledge of acute respiratory failure including the: differential diagnosis and treatment of acute hypoxemic respiratory failure (eg, pneumonia, pulmonary edema, alveolar hemorrhage, lobar collapse) differential diagnosis and treatment of ventilatory failure (eg, status asthmaticus, COPD exacerbation, neuromuscular weakness, drug overdose) 2. propose a plan of care to manage patients on mechanical ventilatory support utilizing the following when appropriate
non-invasive ventilation
intubation and mechanical ventilation
basics of volume-cycled ventilation and pressure support ventilation
means for triggering the machine breath including:
controlled mechanical ventilation
assist/control ventilation
synchronous intermittent mandatory ventilation
pressure support ventilation
essentials and utility of measuring airway resistance, static compliance of the respiratory system and auto-PEEP
indications for (and risks of) machine set PEEP
relationship between ventilator settings and hemodynamics
relationship between ventilator settings and arterial blood gases
complications of mechanical ventilation:
ventilator-induced lung injury
laryngeal and tracheal injury
nosocomial infections: sinusitis and ventilator associated pneumonia
approach to patients with obstructive lung disease and ARDS
process of weaning and extubation 3. interpret simple and mixed acid-base disorders with appropriate changes in mechanical ventilation as needed 4. classify the four categories of shock in terms of pathophysiology, hemodynamic profiles files and treatment
hypovolemic shock
septic/distributive shock (SIRS, sepsis, severe sepsis, anaphylaxis, etc)
cardiogenic shock
obstructive shock
5. choose the suitable volume replacement therapy and drug support for patients exhibiting the signs and symptoms of shock
the use of crystalloid and colloid fluid replacement
indications for vasopressor and inotropic drug support
6. administer the appropriate goal directed therapy based on hemodynamic measurements obtained from the utilization of various modalities
central venous catheters
pulmonary artery catheters
non-invasive measures of cardiac output
7. prepare a plan for patients with altered mental status during their ICU stay
use of sedatives and paralytics
identification and treatment of drug/alcohol withdrawal syndromes
use of the Glascow Coma Scale
identification of metabolic and anoxic encephalopathy
criteria for brain death
criteria for persistent vegetative state and coma 8. determine an approach to fever in the intensive care unit including
the diagnosis and treatment of hospital acquired infections
knowledge of noninfectious causes of fever 9. prepare a plan of care for patients with gastrointestinal bleeding (GIB) including
the approach to GIB
the importance of stress ulcer prophylaxis 10. apply venous thromboembolism prevention in the ICU 11. distinguish between treatment plans for anemia, thrombocytopenia and coagulopathy in the ICU 12. compare different assessment and management plans for patients in critical care with a diagnosis of poisoning
the general approach to the poisoned patient
the treatment of acetaminophen poisoning
the basics of non ethanol alcohol poisoning
the treatment of anticholinergic poisoning 13. recognize the effect of acute illness severity, age and prior health on the ability to tolerate critical illness through the utilization of the APACHE II scoring system in critically ill patients 14. recognize the ethical and legal aspects of withdrawal and withholding of life support and the appropriate use of the DNR order | 
