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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%.
(Manpower required - 1400 students)
• Positive-pressure ventilators developed (Engstrom)
Intensive Care Medicine
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
Intensive Care Medicine
Principles
• Diffusion (Fick’s law)
• Filtration
• Absorption
Intensive Care Medicine
Change over time:
• Equipment• Environment• Patients are older, sicker with higher
expectations
Intensive Care Medicine
Help:• Colleagues
• Nurses
• ITU guidelines
• Computer
Intensive Care MedicineThe ICM team:Consultants (11)
Trainees (21)Parent specialty doctors
Microbiologists, pathologists Nursing staffTechniciansSecretaries
PhysiotherapistsPharmacistsDieticians
ReceptionistsCleaners
Intensive Care Medicine
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
Intensive Care Medicine
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
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
Intensive Care Medicine
Ward round• System-based presentation:
CVS
RespiratoryNeurologicalRenalGI tractHaematological/ Infections
• Problems• Management plan
Intensive Care Medicine
Duties:
• Interventions
• Referrals
• Relatives
• Discharge summaries
• Death Certificates
Intensive Care Medicine
“ACCS paperwork”
• 6 DOPS
• 3 Mini Cex
• 4 CBD
• 1 MSF
• FICM documentation
• Educational Supervisor Report
Intensive Care Medicine
Single/Dual CCT’s:• Entry routes: Anaesthetics, CMT, EM
ACCS• Primary exam • Primary FICM exam not running yet
(2014?)
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
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 Anaesthetics1 year ICM1 year AM
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
Intensive Care Medicine
Stage 3 ICM training:
• 1 year of advanced ICM training
Intensive Care Medicine
Dual CCT’s:• CT of 2nd specialty• 2 Applications (within 18 months)• Additional 18 months of training needed• Overlap of competencies
Intensive Care Medicine
Why dual CCT?• Broadens working opportunities• Increasing demand for ICM consultants• Anaesthetics: “peri-operative physician”• AM/EM: close links
Thank you!
Questions?
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