Goals and objectives – em university of pittsburgh department of critical care medicine anoxic brain injury

Patient care

Demonstrate appropriate, evidence based, direct care to patients with critical illness and injury, including life threatening trauma and multi-system organ failure.

Demonstrate appropriate, evidence based, direct care to post-operative patients from cardiothoracic, vascular, gastrointestinal, genitourinary, endocrine, orthopedic, neurosurgical, plastics, head and neck, heart/lung transplant, and abdominal transplant procedures.

Demonstrate knowledge and competency in:

Resuscitation skills including advanced cardiopulmonary resuscitation, crisis management and acute trauma assessment and resuscitation

Laryngoscopy and intubation techniques, including rapid sequence induction, in patients with critical illness or injury.Anoxic brain injury demonstrate the proper immobilization technique for intubating patients with potential cervical spine injury and the proper pharmacologic management for patients with elevated intracranial pressure.

Ventilator management including the use of volume, pressure and dual modes, PEEP, supplemental oxygen, and lung protective ventilation strategies

The performance of bedside procedures, specifically central venous lines, arterial lines, intubations, percutaneous and open tube thoracostomy, pulmonary artery catheterization, thoracentesis, paracentesis and fiberoptic bronchoscopy.

Demonstrate knowledge and competency with emergent airway management using bag and mask ventilation in non-intubated, conscious and unconscious, paralyzed and non-paralyzed patients.Anoxic brain injury

Demonstrate proper management of invasive monitoring devices, including central venous pressure and oximetery, arterial pressure, pulmonary arterial pressure, cardiac output, and intracranial pressure assessment.

Apply clinical criteria of brain death and basic principles of support for potential organ donors. Demonstrate proper performance of brain death certification.

Demonstrate the proper assessment and management of patients with intracranial hypertension, including evaluation of data from ICP monitors.

Demonstrate proper management for patients requiring large volume fluid and blood product resuscitation.

Demonstrate competency in the performance of emergent consultation to emergency department, post-anesthesia recovery, med-surg wards, and icus.Anoxic brain injury

Identify, evaluate, and prioritize current ICU patient care needs by participating in daily rounds on critically ill patients.

Identify and prioritize current and future patient care needs through participation in daily gate-keeping activities.

Medical knowledge

List and describe the most current evidence-based medical practices pertaining to the treatment of critically ill patients.

State the etiology, describe the pathophysiology, demonstrate the appropriate management and evaluate the outcomes of patients with:

Cardiovascular instability including arrhythmias, myocardial infarction, congestive heart failure, vascular abnormalities, and shock.

Respiratory failure including acute respiratory distress syndrome, chronic obstructive lung disease, respiratory muscle weakness, pneumonia, tension pneumothorax, and pulmonary embolus

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Acute and chronic renal insufficiency

Central nervous system pathology including encephalopathy, cerebral vascular accidents and brain death

Metabolic, endocrine and electrolyte abnormalities

Infectious diseases including sepsis and septic shock. Differentiate treatment plans for patients who are immunocompetent versus immunosuppressed

Hematologic disorders including anemia, neutropenia, thrombocytopenia and thrombocytosis

Acute allergic reactions and/or anaphylaxis

Gastrointestinal diseases including acute and chronic liver failure, pancreatitis, cholecystitis, gastritis, peptic ulcer disease, and upper and lower gastrointestinal hemorrhage

Genitourinary pathology

Multi system trauma including traumatic brain injury, blunt and penetrating thoracic and abdominal trauma

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Thermal injuries

Nutritional disorders

Oncologic complications

Psychiatric disorders causing special ICU problems

Describe the strategies to manage ethical and legal dilemmas between patients, families, and staff in the ICU.

List the risks, benefits, indications, and contraindications of bedside procedures such as central and arterial lines, intubations, chest tubes, pulmonary artery catheters, needle thoracostomy, and fiberoptic bronchoscopy.

List the risks, benefits, indications, and contraindications for ICP monitor or extra-ventricular drain placement and describe the possible limitations and complications of these devices.

List the risks, benefits, indications, and contraindications for insertion of esophago-gastric balloon tamponade devices.Anoxic brain injury describe the uses and limitations of these devices.

Demonstrate knowledge of central venous and pulmonary artery catheter data interpretation by listing the differential diagnosis, evaluating the catheter data in relation to other patient data and trends, and describing subsequent steps in assessment and/or management.

Demonstrate knowledge of electrocardiogram interpretation by listing the differential diagnosis, evaluating the ECG in relation to other patient data and trends, and describing subsequent steps in assessment and/or management.

Demonstrate knowledge of ABG, VBG, and other laboratory data interpretation by listing the differential diagnosis, evaluating the data in relation to other studies and patient trends, and describing subsequent steps in assessment and/or management.Anoxic brain injury

List the indications for:

Extra-corporeal membrane oxygenation and describe its function.

Use of a ventricular assist device and describe its function.

Use of an intra-aortic balloon pump and describe its function.

State the etiology, describe the pathophysiology, demonstrate the appropriate pharmacological management and evaluate outcome of patients with circulatory insufficiency. Determine whether this pharmacological support is adequate or whether further fluid or mechanical circulatory support is needed.

Demonstrate knowledge of the pharmacokinetics, pharmacodynamics, metabolism, and excretion of various drugs used in the ICU.

List indications for:

The insertion of transvenous temporary cardiac pacemakers.Anoxic brain injury

The management of intra-aortic balloon pumps for surgical and non-surgical patients in the ICU.

Practice-based learning and improvement

Identify the best practice patterns to facilitate care of the critically ill patient from VAPHS and UPMC health system operating procedures and patient interactions.

Interpret, critique, and evaluate medical literature. Discuss biostatistics and debate experimental design.

Demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities including core lecture series, educational workshops, educational modules, journal club, grand rounds, research conferences, and quality improvement conferences.Anoxic brain injury

Demonstrate motivation for improvement of procedural skills by completion of mandatory procedure forms verifying satisfactory performance with endotracheal intubation, central venous, pulmonary artery and arterial line insertion and chest thoracostomy insertion.

Demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal patient outcomes on daily rounds, describing the care received by the patient, and comparing the care received to the current standard of care.

List and describe the barriers to incorporation of evidence-based practices into patient care.

Identify systemic threats to patient safety through chart review. Describe measures to prevent adverse events and the barriers to implementation of such measures.Anoxic brain injury

Interpersonal and communication skills

Demonstrate effective communication with UPMC or VAPHS nursing staff, peers, attending and referring physicians, consultants, center for organ recovery representatives (CORE), and other health care professionals including respiratory therapists, nutritionists, pharmacists, physical therapy, and study technicians.

Establish a rapport with patient and family and demonstrate patient and attentive listening to their concerns.

Demonstrate effective discussion of patient diagnoses, prognosis, and management plan (including risks, benefits, and side effects) with patient and family using simple, easily understood language.

Demonstrate proper written and verbal techniques for transfer of care both within and between services.Anoxic brain injury

Develop teaching skills through instruction of medical and procedural aspects of critical care medicine to first year CCM fellows, UPMC interns and residents, university of pittsburgh medical students, and other health care professionals through bedside teaching as well as formal didactic sessions.

Demonstrate effective communication with nurse managers in order to establish ICU admission and discharge plans for critically ill patients.

Demonstrate the ability to orchestrate care with other medical and surgical services.

Professionalism

Demonstrate proper performance of all expected professional responsibilities.

Demonstrate the practice of ethical principles in relation to patient care and confidentiality, including obtaining informed consent, implementing “do not resuscitate” orders, withholding or withdrawing life sustaining therapies, and clarifying goals of care from advance directives or patient surrogates.Anoxic brain injury

Demonstrate ethical interactions with pharmaceutical representatives and be unbiased in prescribing habits.

Demonstrate sensitivity to cultural, age, gender and disability issues.

Systems-based practice

Describe the role of critical care medicine within the UPMC health system or VAPHS.

Evaluate and demonstrate cost-effectiveness of care for critically ill patients

Develop proper documentation and billing skills.

Demonstrate enthusiasm for expansion of medical knowledge through participation in quality improvement projects and clinical trials occurring on patients in the ICU.

Demonstrate consultation skills by identifying a specific need or question and contacting the appropriate medical, surgical, or support service to provide efficient and effective patient care.Anoxic brain injury

Demonstrate awareness of the role of the UPMC health system or VAHSP in regional health care delivery through compliance with standard operating procedures and participation in quality improvement initiatives.

Orchestrate the pre- and inter-hospital transportation of critically ill patients.