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Intensive Care for the Developing World

The BASIC approach Colin Graham & Charles Gomersall. Intensive Care for the Developing World. Challenges. Education Equipment Supplies Finances…. What is Intensive Care?. Increased nursing capability…. What is Intensive Care?. What is Intensive Care?. Level 1. Monitoring

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Intensive Care for the Developing World

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  1. The BASIC approach Colin Graham & Charles Gomersall Intensive Care for the Developing World

  2. Challenges • Education • Equipment • Supplies • Finances….

  3. What is Intensive Care? • Increased nursing capability…

  4. What is Intensive Care?

  5. What is Intensive Care?

  6. Level 1 • Monitoring • HR, NIBP, SpO2, RR, urine output • POCT • Hb • Glucose, electrolytes and renal function test

  7. Level 1 • Organ support: • fluid challenge, blood transfusion • high flow oxygen therapy,& nebulisation of drugs • continuous intravenous infusion of drugs (insulin,heparin, nicardipine, labetolol, dopamine…) with syringe pump • Not epinephrine and norepinephrine • NG nutrition

  8. Level 1 • Patients: • Post-operative (including multiple trauma) • Medical (DKA, severe asthma, severe pneumonia, severe dehydration…) • Obstetric emergencies (including eclampsia)

  9. Level 2 • Level 1 + • Continuous ECG monitoring • POCT • blood gases and cardiac enzymes • Organ support • management of arrhythmias (pharmacological, defibrillation) • NIV • Patients: • cardiovascular emergencies • acute respiratory failure requiring non-invasive ventilation

  10. Level 3 • Level 2 + • Monitoring • invasive BP • Investigations • Microbiology and high level of pathology tests (biochemistry, haematology…) • Organ support: • epinephrine and norepinephrine infusion via central venous catheter • invasive mechanical ventilation • Patients: • multiple trauma, poisoning, infectious disease such as tetanus and severe CNS infections (malaria, meningitis…)

  11. BASIC collaboration • Informal • Intensivists with an interest in providing free, high quality, practical course material • Hosted by Dept of Anaesthesia & Intensive Care, The Chinese University of Hong Kong

  12. BASIC collaboration

  13. “Products” • Packaged, self-contained courses • Focused on specific target audience • Practical • No license fees • Minimal cost

  14. Finances • Dept of Anaesthesia & Intensive Care, CUHK • Commercial sponsorship • Profits from HK-based courses • “Turn the wheel of learning”

  15. BASIC course venues 2005-11 Mumbai, Kolkata,Pune, Jaipur, Chennai, Agra, Coimbatore, Aurangabad Berlin Dublin Sinaia Athens Hama Jerusalem London, Birmingham,Oxford, Colchester, Brighton, Wessex Seoul Kuwait Bahrain Beijing, Shanxi Hong Kong,Guangzhou, Shunde, Hainan, Zhengzhou Riyadh Dubai Khartoum Doha Phnom Penh Muscat Singapore Colombo Fiji Kuala Lumpur Johannesburg,Cape Town, Sun City Bali Brisbane, Sydney Perth Alice Springs Melbourne Adelaide Hawkes Bay, Hamilton, Middlemore, Christchurch

  16. Course material • Course manual • Pre-course “open book” MCQ • CD-ROM • Lectures • Skill stations • Post-course “closed book” MCQ

  17. Course material • Enough for 2.5 days • Usually run over 2 days • Select what is relevant to your situation

  18. Course manual • Addresses knowledge aspect of course

  19. Pre-course MCQ • Aim is to encourage candidates to read course manual • On-line • Immediate feedback • Identify knowledge deficiencies

  20. CD-ROM • Interactive tutorial on arterial blood gas interpretation • Practical application of knowledge • Narrated lecture on acute respiratory failure • CVP line insertion • “Demonstration” component of practical skills teaching

  21. Lectures • Emphasize key points • Case based lectures • Practical application of theoretical knowledge • NOT a textbook projected onto a wall

  22. Skill station • Practice skills • Application of knowledge to solve problems • Revision of key material • Learn from mistakes • Allow the trainee to make mistakes

  23. Post course MCQ • Motivational • Clinical scenarios

  24. Course development • Continuous, iterative process • Tailored to needs of participants • High quality course material • Extensive use of graphics

  25. Laryngeal mask

  26. Courses • BASIC • Very BASIC • BASIC DHS • Not so BASIC • BASIC4NOW • Mechanical ventilation: beyond BASIC • Intensive Care Nephrology: beyond BASIC

  27. What can we offer? • Course material • Experience in course development • Instructors • Train the trainers • Sustainability

  28. Courses • BASIC • Introductory course in Intensive Care (level 3) • Very BASIC • Acute care training for final year medical students and interns, includes non-invasive ventilation (level 2) • BASIC DHS • Acute care training for doctors in developing healthcare systems, not including ventilation (level 1)

  29. How can you help us? • Insight • Purpose

  30. Synergy MSF BASIC Insight Course material Instructors Equipment Resources Staff Feedback SuccessfulIntensiveCare

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