Introduction to Critical Care Science

Module details

Title

Introduction to Critical Care Science

Type

Rotation

Module code

SPS101

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will enable trainees to gain underpinning knowledge, skills and experience of Critical Care Science through introduction to the range of critical care diagnostic, monitoring and therapeutic services provided in the specialism, and the interaction with patients and patient-centred practice. Trainees will be expected to perform some routine procedures and develop and build their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1, 2, 3, 4, 5	Competency Perform all tasks in accordance with relevant procedures/protocols/legislation, including infection control, health and safety, and critical incident reporting, ensuring appropriate patient identity checks are performed and the patient is fully identified on each type of recording.	Action View
# 2	Learning outcome 2,3,4	Competency Respect the dignity, rights, privacy and confidentiality of patients at all times, taking appropriate action to respond to the specific needs of the critically ill patient.	Action View
# 3	Learning outcome 2,3,4	Competency Prepare the environment and set up equipment ready for use for monitoring, therapy or measurement.	Action View
# 4	Learning outcome 2,3,4	Competency Explain the procedure to the patient, if they are fully cognitive, or the relative if present, address any procedure-related questions and gain appropriate consent.	Action View
# 5	Learning outcome 1	Competency Use correct non-touch aseptic technique in the critical care environment.	Action View
# 6	Learning outcome 1	Competency Use correct modified aseptic technique (clean technique) in the critical care environment.	Action View
# 7	Learning outcome 2	Competency Set up a cardiac monitor on adult patients, interpreting and responding to trends in physiological variables.	Action View
# 8	Learning outcome 2	Competency Set up non-invasive blood pressure (BP) monitoring equipment in adult patients, interpreting and responding to trends in physiological variables.	Action View
# 9	Learning outcome 2	Competency Set up oxygen saturation monitoring equipment in adult patients, interpreting and responding to trends in physiological variables.	Action View
# 10	Learning outcome 3	Competency Select, set up and deliver appropriate oxygen therapy, monitoring, interpreting and responding to changes appropriately using nasal cannulae, simple face masks, non- rebreathe masks and venturi masks.	Action View
# 11	Learning outcome 3	Competency Select, set up and deliver appropriate oxygen therapy and nebulising devices, monitoring, interpreting and responding to changes appropriately.	Action View
# 12	Learning outcome 4	Competency Assess the patient’s suitability for the proposed investigation and obtain a blood gas sample suitable for the assessment of blood gas status using a recognised technique.	Action View
# 13	Learning outcome 5	Competency Correctly store medical gases for use in a critical care environment.	Action View
# 14	Learning outcome 5	Competency Assist in the connection of medical gases to wall outlets and cylinders.	Action View
# 15	Learning outcome 6	Competency Use the National Early Warning Scoring system in relation to critical care.	Action View
# 16	Learning outcome 7	Competency Critically evaluate a range of critical care monitoring, therapeutic and diagnostic services and treatment pathways for critically ill patients.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Set up equipment and consumables to measure NIBP on patient	DOPS
Perform IQC on Blood Gas Analyser discuss clinical relevance	DOPS
Set up and connect CPAP circuit to patient	DOPS
Set up and perform pre use checks on Mechanical Ventilator	DOPS
Perform a blood gas measurement and discuss the results	DOPS
Prepare and connect consumables to facilitate ETCO2 monitoring on a ventilated patient	DOPS
Attend an equipment repair or calibration and introduce yourself to the relatives explaining the reason for the event	OCE
Introduce yourself to a patient during the set up of a piece of equipment at the bedside	OCE

Learning outcomes

1. Use correct aseptic technique and aseptic handling of medical devices in the critical care environment.
2. Perform a range of bedside monitoring techniques and be able to interpret acute events and actions required, differentiating between physiological and technical abnormalities in patient monitoring techniques. (This should include ECG monitoring, oxygen saturation monitoring and non-invasive BP monitoring.)
3. Administer oxygen therapy across a range of delivery systems to critically ill patients.
4. Perform a blood gas measurement and describe its clinical relevance.
5. Store medical gases correctly, ensuring adherence to the safety issues in the context of the critical situation.
6. Use the National Early Warning Scoring system in relation to critical care.
7. Document local diagnostic and treatment pathways for critically ill patients within a critical care environment.

Learning outcomes

1. Describe and explain the role of the Critical Care Scientist (CCS) in the care of patients and within the healthcare team.
2. Describe infection control, risks and emergency procedures within the critical care environment.
3. Know the criteria for admission to, and discharge from the intensive care unit (ICU), including factors influencing intensity and site of care (ward, high dependency unit [HDU], ICU).
4. Describe the pathophysiology of common diseases that result in admission to an ICU.
5. Recall and apply knowledge of basic healthcare science with respect to the cardiovascular, respiratory and renal systems to explain a range of typical patient scenarios relevant to critical care science.
6. Explain how to recognise and respond to adverse trends in monitored parameters.
7. Describe the principles of ECG monitoring.
8. Describe the clinical framework for and basic principles of the following within a critical care environment:
   • patient monitoring systems
   • date interpretation and management
   • oxygen therapy techniques
   • blood gas analysis.
9. Recognise the legal and ethical issues arising from caring for an acutely ill patient.
10. Explain and justify the use of the Alert, Voice, Pain, Unresponsive (AVPU) system in the care of critically ill patients.

Indicative content

Techniques and functions performed by a critical care scientist

• Physiological support, measurement and clinical intervention including: respiratory, cardiovascular, renal and hepatic, neurological and gastroIntestinal
• Health and Safety, Risk Assessment and Clinical Governance

Common respiratory, cardiac and metabolic diseases resulting in ICU admission, including:

• Asthma
• Chronic lung disease
• Pneumonia and respiratory tract infections
• Chest trauma
• Ischaemic heart disease
• Circulatory collapse/shock
• Cardiac arrhythmia
• Biochemical, endocrine or metabolic derangement
• Common congenital cardiac disorders

Anatomy and physiology of the cardiovascular system

Respiratory system

• Control of respiration
• Diseases affecting gas transfer in the respiratory system.
• Physical limitations of gas movement within the respiratory tract
• Ventilation/perfusion matching

Cardiovascular system

• Structure and function of blood vessels
• Coronary circulation
• Capillary exchange
• Factors affecting blood flow
• Control of blood pressure and flow
• Shock and homeostasis
• Circulatory routes
• Cardiac output
• Cardiac cycle
• Normal and abnormal haemodynamic and ECG response to exercise
• Overview of pathophysiology of acquired, congenital and ischaemic heart disease

Renal system

• Structure and function of the kidneys
• Evaluation of kidney function
• Factors affecting renal function/perfusion

Blood

• Characteristics
• Haemostasis
• Blood groups and types
• Typing and cross-matching
• Clotting cascade
• FBC

Fluid, electrolyte and acid-base homeostasis

• Fluid compartments and fluid balance
• Oedema

Infection control

• Types of organisms
• Modes of transfer
• Protective strategies

ECG monitoring

• Heart rate
• Rhythm
• Conduction
• ST segment change
• QT interval
• Indications
• Limitations
• Techniques
• Advantages and disadvantages of different lead configurations

Devices used in the treatment of critically ill patients

• Type of devices used in the treatment of critically ill patients
• Scientific principles of minimal patient monitoring systems
• Application of minimal patient monitoring techniques
• Normal/abnormal and artefacts and inaccuracies associated with outputs from minimal patient monitoring systems
• Clinical significance of outputs from minimal patient monitoring systems
• Essential services and the relevant safety systems
• Ventilation and the process of ventilation
• Suction devices
• Syringe drivers
• Computers and data recording systems
• Storage of medical gases and the safety issues
• National Early Warning Scoring system in relation to Critical Care.

Activities

• Observe and assist in capnography (CO2) monitoring and invasive pressure monitoring and discuss the principles and place of bedside monitoring, including the hazards of inappropriate monitoring, misuse of alarms and principles of disconnection monitors with your training officer.
• Observe a range of routine procedures in Critical Care Science and critically evaluate how these investigations contribute to the diagnosis, management and care of patients, considering the range of needs of people with disabilities within a typical care pathway for patients with common cardiac diseases.
• Work with a critical care clinical scientist or equivalent and describe the role of the critical care scientist in the care of the acutely ill patient and the wider role within the clinical team.
• Attend a range of theatre sessions where critically ill patients are treated and reflect on the essential services and the relevant safety systems in place throughout critical care and theatre.
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with disorders of the cardiovascular system.