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Introduction to Intensive Care Medicine for ACCS trainees

Introduction to Intensive Care Medicine for ACCS trainees. Sabine Eggert Swansea 2012. Intensive Care Medicine. Copenhagen 1952 – Ibsen: Technique of positive pressure ventilation widely adopted in polio epidemic with mortality reduction from 90% to 25%.

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Introduction to Intensive Care Medicine for ACCS trainees

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  1. Introduction to Intensive Care Medicine for ACCS trainees Sabine Eggert Swansea 2012

  2. Intensive Care Medicine • Copenhagen 1952 – Ibsen: Technique of positive pressure ventilation widely adopted in polio epidemic with mortality reduction from 90% to 25%. (Manpower required - 1400 students) • Positive-pressure ventilators developed (Engstrom)

  3. Intensive Care Medicine

  4. Intensive Care Medicine • 1970–1980’s – modern concept of critical illness developed. Respiratory support only run by anaesthetists • 1999 - Awarded specialty status • 2000 - IBITCM established • 2002 - Dual CCT in ICM • 2010 - FICM approved • 2012 - Single CCT in ICM

  5. Intensive Care Medicine

  6. Principles • Diffusion (Fick’s law) • Filtration • Absorption

  7. Intensive Care Medicine Change over time: • Equipment • Environment • Patients are older, sicker with higher expectations

  8. Intensive Care Medicine Help: • Colleagues • Nurses • ITU guidelines • Computer

  9. Intensive Care Medicine The ICM team: Consultants (11) Trainees (21) Parent specialty doctors Microbiologists, pathologists Nursing staff Technicians Secretaries Physiotherapists Pharmacists Dieticians Receptionists Cleaners

  10. Intensive Care Medicine

  11. Intensive Care Medicine Swansea • 28 ITU beds in Morriston Hospital • No. of admissions: over 1100 per year • 42% surgical, 58% medical • Tertiary centre – trauma / vascular / pancreatic disease / renal • Other critical care areas: • Burns unit • Cardiac ITU

  12. Intensive Care Medicine

  13. Intensive Care Medicine • Induction Meeting, Appraisal meetings • 2 ACCS trainees on 1st on call rota • Allocated to one section of the unit during morning hand-over • 2 consultant-led ward rounds • Member of trauma and arrest team • Ward referrals

  14. Intensive Care Medicine • Microbiology ward rounds • Weekly audit / case presentations and journal clubs • Weekly team based “long stay” patient reviews • X ray teaching • Bed side teaching

  15. Intensive Care Medicine Ward round • System-based presentation: CVS Respiratory Neurological Renal GI tract Haematological/ Infections • Problems • Management plan

  16. Intensive Care Medicine Duties: • Interventions • Referrals • Relatives • Discharge summaries • Death Certificates

  17. Intensive Care Medicine “ACCS paperwork” • 6 DOPS • 3 Mini Cex • 4 CBD • 1 MSF • FICM documentation • Educational Supervisor Report

  18. Intensive Care Medicine Single/Dual CCT’s: • Entry routes: Anaesthetics, CMT, EM ACCS • Primary exam • Primary FICM exam not running yet (2014?)

  19. Intensive Care Medicine Single CCT: • Competitive entry at ST3 level • Primary exam in entry specialty • Annual interviews in ICM • National interview process • Soon: applications for ACCS ICM possible

  20. Intensive Care Medicine Stage 1 ICM training: • Appointments into ST3 and ST4 ICM training • At the end of ST4 every trainee will have had: 1 year Anaesthetics 1 year ICM 1 year AM

  21. Intensive Care Medicine Stage 2 ICM training: • ST 5 year with specialty experience (cardiac, neuro, paeds plus other) • ST 6 special interest • Compulsory FICM exam: ST 5/ ST6 level

  22. Intensive Care Medicine Stage 3 ICM training: • 1 year of advanced ICM training

  23. Intensive Care Medicine Dual CCT’s: • CT of 2nd specialty • 2 Applications (within 18 months) • Additional 18 months of training needed • Overlap of competencies

  24. Intensive Care Medicine Why dual CCT? • Broadens working opportunities • Increasing demand for ICM consultants • Anaesthetics: “peri-operative physician” • AM/EM: close links

  25. Thank you!

  26. Questions?

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