In Critical Care Medicine Academy, Dr. Peter Sloane starts with an in-depth review of the pathophysiology of respiratory failure and ARDS, ventilator management strategies, acid-base disorders, sepsis syndrome and cardiovascular emergencies. This is followed by a mini-course on basic point-of-care-ultrasound (POCUS) by Dr. David Weisman, with focus on pulmonary and cardiac ultrasound imaging. Finally, Dr. Brian Bohner provides an overview of neurologic, gastrointestinal, hematologic/oncologic, and endocrine emergencies. This course provides the student with a broad knowledge base of the pathophysiology of the critically ill patient and the tools to assess and manage this challenging population.
Learning Objectives
Session 1: Introduction – Respiratory Failure and Mechanical Ventilation
Summarize the indications for mechanical ventilation and ventilation goals
Describe basic lung mechanics
Recognize and prevent ventilator-induced lung injury
Appreciate the benefits and deleterious effects of PEEP and auto-PEEP
Understand modes of mechanical ventilation
Manage ventilator-patient asynchrony and basic ventilator alarms
Differentiate between weaning and extubation strategies
Describe the principles of non-invasive ventilation
Session 2: Pulmonary Emergencies: ARDS, Pulmonary Embolism and Pneumothorax
Describe clinical, radiographic, pathologic and physiologic characteristics of ARDS
Recognize types of ventilator-induced lung injury (VILI)
Apply ventilator strategies to minimize VILI
Understand therapeutic options for advanced therapy for patients with severe ARDS
Appreciate the clinical manifestations, diagnostic algorithm, and management of pulmonary emboli and pneumothorax
Session 3: Acid-Base Disorders and Acute Renal Insufficiency
Identify a simple (single) acid-base disorder
Understand the appropriate acute and chronic compensation to single disorder
Discern difference between uncompensated, acutely compensated, partially compensated and fully compensated disorders
Recognize a second primary (double) disorder
Expose “hidden” and “complex” acid-base disorders
Know the differential diagnosis of the six primary acid-base disorders
Use patient history to more accurately identify acid-base disorders
Appreciate the pathophysiology, diagnostic strategy, and management of acute lung injury in the ICU setting
Session 4: Sepsis Syndrome, Septic Shock and ICU infections
Recall the international consensus definition of sepsis and septic shock
Describe the continuum of sepsis from mild to shock
Understand the recommendations from the Surviving Sepsis Campaign
Synthesize these recommendations to competently manage patients with sepsis
Appreciate the pathophysiology, diagnostic strategy, and management of nosocomial ICU infections
Session 5: Cardiovascular Emergencies
Understand the physiology and application of invasive hemodynamic monitoring and its application to fluid and vasoactive support
Competently interpret EKGs and recognize ischemia, injury and infarction
Define HTN emergency and its management
Recognize common brady and tachyarrhythmias
Understand the pathophysiology and management of CHF
Session 6: Point of Care Ultrasound
Understand the underlying physics, transducers and orientation of ultrasound
Identify normal anatomic structures on cardiac and pulmonary ultrasound
Recognize basic sonographic pathology for cardiac and lung imaging
Putting it altogether with POCUS cases
Session 7: Neurologic Emergencies in the ICU
Understand treatment of the patient with traumatic brain injury (TBI)
Develop skills to workup and treat patient with status epilepticus
Recognize time sensitive steps in managing patient with acute stroke syndrome
Differentiate the causes and management of neuromuscular disease in the ICU patient
Describe criteria for establishing brain death
Session 8: GI and Hematologic/Oncologic Emergencies
Prioritize management of acute GI bleed
Differentiate the approach in managing acute and chronic liver failure
Understand assessment and treatment of acute pancreatitis
Understand appropriate indications for blood product replacement and reversing coagulopathy
Review treatment for sickle cell crises
Recognize oncologic related emergencies and how to initiate the appropriate therapy
Session 9: Endocrine Emergencies
Understand management of hyperglycemia and hypoglycemia in hospitalized patients
Recognize clinical presentation and treatment priorities for patients with life-threatening diseases of the pituitary, adrenal, and thyroid glands
Understand the causes and acute management of electrolyte derangements in ICU patients
Session 10: Critical Care Medicine – Potpourri
Recognize patients in ICU at specific outcome risk based on nutritional status
Understand the strategies in providing nutrition that impact on outcome
Review advantages of enteral over parenteral nutrition in first several days of critical illness
Understand changing nutritional requirements over first several days in ICU
Recognize the role of the palliative care team in supporting patients in ICU as well as their caregivers
Understand specific ICU patients who will derive most benefit from these services
Appreciate barriers to providing this care
Review outcomes that improve with Palliative Care integration into critical care team
PSA is a groundbreaking education tool for any resident interested in solidifying their foundation in pulmonary and sleep medicine as well as expanding their knowledge base into the intricacies of these fields. The format is easy to follow, no matter what level of medicine you’re at. This is a valuable tool for medical students and residents. I highly recommend it to those interested in pulmonary, critical care or anesthesiology. The programs will allow you to develop a comfort level with topics that may be difficult to comprehend.
Justin Gurges, Resident Physician New York, NY
PSA was highly informative and challenging. The speakers were clear and concise in their delivery. Explanations were provided with the post questions explaining all answers. I also like the way the session was broken up.
Karen Viets, RN Saint Augustine, Florida
I am a practicing Emergency Medicine physician in North Carolina and want to improve my knowledge of critical care and pulmonary topics. When I heard about PSA, I knew this would be a great way to do that. And so far through the pulmonary course, it definitely has been! It’s been both a great review of the basic medical school concepts while also introducing and explaining higher level clinical pearls. The presentations are clear and the graphics put some of the complex ideas into nice visual depictions that are way better than any text description could be. The built-in test questions and ability to earn CME are great additions as well. This has been a fantastic educational opportunity. I highly recommend it to any clinical provider who wants to advance his or her knowledge of important pulmonary topics!