Critical Care Clerkship Goals and Objectives

Goals

Upon 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

Objectives
Upon completion of the critical care clerkship, students should be able to:
1. employ fundamental knowledge of acute respiratory failure including the
a.        differential diagnosis and treatment of acute hypoxemic respiratory failure (eg, pneumonia, pulmonary edema, alveolar hemorrhage, lobar collapse)
b.        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
a.         non-invasive ventilation
b.        intubation and mechanical ventilation
c.         basics of volume-cycled ventilation and pressure support ventilation
d.        means for triggering the machine breath including

i.                     controlled mechanical ventilation

ii.                    assist/control ventilation

iii.                  synchronous intermittent mandatory ventilation

iv.                  pressure support ventilation
e.         essentials and utility of measuring airway resistance, static compliance of the respiratory system and auto-PEEP
f.          indications for (and risks of) machine set PEEP
g.        relationship between ventilator settings and hemodynamics
h.        relationship between ventilator settings and arterial blood gases
i.          complications of mechanical ventilation

i.                ventilator-induced lung injury

       ii.           laryngeal and tracheal injury

iii.                  nosocomial infections: sinusitis and ventilator associated pneumonia
j.          approach to patients with obstructive lung disease and ARDS
k.         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
                  a.     hypovolemic shock
                  b.     septic/distributive shock (SIRS, sepsis, severe sepsis, anaphylaxis, etc)
                  c.     cardiogenic shock
                  d.     obstructive shock
5. choose the suitable volume replacement therapy and drug support for patients exhibiting the signs and symptoms of shock
                 e.           the use of crystalloid and colloid fluid replacement
                 f.            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
a.        central venous catheters
b.       pulmonary artery catheters
c.        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

a.        the diagnosis and treatment of hospital acquired infections

b.       knowledge of noninfectious causes of fever

9.  prepare a plan of care for patients with gastrointestinal bleeding (GIB) including

a.        the approach to GIB

b.       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

a.        the general approach to the poisoned patient

b.       the treatment of  acetaminophen poisoning

c.        the basics of non ethanol alcohol poisoning

d.       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