sábado, 23 de julio de 2011



Domain 1.5: Medical and Perioperative Care of the Critically ill / General Intensive Care

a. Knowledge

 Organization of Intensive Care Units and ICU standards including:

o Evaluating and taking into consideration the difficulty and complexity of the tasks in relation to resources, qualifications, as well as local organization.

o Identifying patients with need for treatment beyond local competencies according to national organization and take initiative to organize transport for these patients

o Coordinating the multidisciplinary approach of patients and providing cooperation with all relevant partners, with proper respect for their medical competences and roles in specific situations.

o Contribute to the holistic vision of a homogeneous team interacting both with patients and peers, and providing consensual information.

o Medical auditing in intensive care

 General principles of ICU management:

o Airway management and respiratory support including non-invasive techniques

o Hemodynamic management including advanced cardiovascular monitoring and inotropic and vasoactive therapy

o Fluid and electrolyte support including relevant aspects of blood product transfusion

o Renal replacement therapy

o Neurological management

o Enteral and parenteral nutritional support

o Infectious diseases and antibiotic therapy; antiviral therapy; rules for hospital hygiene

o Prevention of complications such as thromboembolism, ventilator associated injuries, stress ulceration, renal failure and nosocomial infection

o Transportation

o Sedation and pain management including treatment of delirium and anxiety of the critically ill patient using both pharmacologic and non-pharmacologic means

o Appropriate knowledge and use of use scoring systems (APACHE; SAPS; TISS; NEMS)

 Aetiology, pathophysiology, diagnosis and treatment plans according to international standards of specific critical conditions:

o Acute circulatory failure

 Shock

 Cardio-respiratory arrest

 Cardiac arrhythmias

 Ischemic heart disease

 Cardiomyopathy

 Valvular heart disease including endocarditis

 Pulmonary embolism

 Anaphylaxis

o Respiratory failure


 Pulmonary oedema

 Airway obstruction and stenosis

 Pneumothorax

 Aspiration

 Pneumonia

 COLD/COPD and Asthma

o Renal failure

 Chronic and acute (RIFLE)

o Gastrointestinal failure

 Bleeding

 Ileus

 Peritonitis of various aetiologies (including colitis and intestinal ischemic disease)

 Pancreatitis

 Liver failure

 Digestive fistulas

o Neurological failure

 Delirium and Coma

 Cerebrovascular and bleeding diseases

 Cerebral oedema

 Increased intracranial pressure including monitoring

 Brain stem death

 Seizures

 Guillain Barré syndrome and Myasthenia gravis

o Trauma

 Head/Face injury and spine injury

 Airway and chest injuries

 Aortic injuries

 Abdominal trauma

 Pelvic and long bone injuries

 Massive transfusion

 Burns and electrocution

 Near-drowning

 Hyper- and hypothermia

o Inflammatory diseases


o Infectious diseases

 Sepsis including sepsis bundle strategy

 Severe community acquired infections (e.g. meningitis)

 Severe nosocomial infections (e.g. MRSA)

 Fungal infections

o Endocrine and metabolic disorders

 Diabetes mellitus and insipidus

 Addison’s disease, Cushing and Conn syndrome

 Thyroid disorders

 Pheochromocytoma

 Malnutrition

 Carcinoid

o Coagulation disorders


 Transfusion reaction

o Obstetric complications

 HELLP syndrome, Pre-eclampsia, Eclampsia

 Septic abortion

 Amniotic fluid embolism

o Intoxications

o Organ donor and the transplanted patient

b. Skills

Technical skills:

 Respiratory

o Intubation under emergency situations

o Bronchoscopy (including lavage and sampling)

o Percutaneous tracheostomy

o Pleural drainage

o Ventilation in prone position

 Cardiovascular

o Basic and advanced life support

o Central vascular access (including for haemodialysis)

o Arterial access

o PA catheterization (Swan-Ganz)

 Basic ultrasound techniques for:

o Ultrasound-guided central venous line placement;

o Recognition of severely abnormal ventricular function (right or left ventricle; hypo- or hyperkinesia);

o Measurement of inferior vena cava diameter;

o Recognition of large pericardial, pleural, or abdominal effusion;

o Recognition of urinary retention (distended bladder).

Clinical and case management skills:

Trainees are expected to understand relevant principles, apply knowledge in practice and to demonstrate clinical skills and management in the following areas grouped by organ systems:

 General

o Proper and clear documentation including list of differential diagnosis and priorities

o Transportation both inter and intra-hospital of the critically ill patients

 Cardiovascular

o Basic and advanced life support including resuscitation decisions and appropriate fluid-strategy

o Use of vasoactive/catecholamine drugs and agents

o Management of arrhythmias including pacemaker and cardioversion

o Application of advanced hemodynamic monitoring (i.e. pulmonary artery catheter, less invasive monitoring such as ultrasound techniques)

o Prevention of thromboembolism

 Respiratory


o Mechanical ventilation including NIV (Modes of mechanical ventilation, indications, contraindications, protective strategy etc)

o Blood gas analysis

o Prevention of lung injuries associated with mechanical ventilation

o Prevention of aspiration

 Renal

o Application of renal replacement therapy

o Prevention of renal function deterioration

o Drug-administration in according to renal function

 Neurological

o Maintenance of cerebral perfusion

o Management of the unconscious patient

o Management of brain stem death

o Management of organ donation

o Management of critically ill polyneuropathy

 Gastrointestinal

o Nutritional support

o Prevention of stress ulceration

o Management of gastroparesis, paralytic ileus, diarrhoea, constipation both pharmacologic and non-pharmacologic.

 Trauma

o Systematic priority-based approach to severe trauma

o Control of bleeding and management of complications

 Endocrinology

o Management of critical illness-induced hyperglycaemia

o Management of over- and under-activity of thyroid

o Management of adrenal and pituitary disorders and sepsis-induced relative adrenal insufficiency

c. Specific attitudes

 Establishing effective communication and interaction with ICU colleagues and other specialists

 Establishing effective communication and interaction with ICU patients and their relatives.

 Recognizing psychological issues relevant to ICU patients and their relatives.

 Strategies to provide informed consent and disclosure of risk when consulting with ICU patients and their relatives.

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