Life Support and Emergency Resuscitation

Module details

Title

Life Support and Emergency Resuscitation

Type

Specialist

Module code

SPS123

Credits

10

Requirement

Compulsory

Aim of this module

This module will enable critical care trainees to identify the clinical signs and typical conditions associated with critical illness and resulting in admission to a critical care environment. Trainees will be able to perform techniques of advanced mechanical ventilation, managing, monitoring and interpreting to maximise clinical effectiveness and enhance safe patient care. Trainees will also be expected to perform a range of other life support and emergency resuscitation techniques. Trainees will be expected to build on the competence gained in the earlier module, building their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1, 2, 4, 5, 6	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 .1, 2, 4, 5, 6	Competency Respect the dignity, rights, privacy and confidentiality of patients at all times, taking appropriate action to respond to the specific needs of each patient.	Action View
# 3	Learning outcome 1	Competency Select the appropriate mode of ventilation related to the patient’s sedation level.	Action View
# 4	Learning outcome 1	Competency Select the appropriate pattern of ventilation with respect to the patient’s lung pathology/pathophysiology.	Action View
# 5	Learning outcome 1	Competency Diagnose common problems associated with ventilator testing and application.	Action View
# 6	Learning outcome 2	Competency Set up and perform pre-use checks on high frequency oscillatory ventilation (HFOV) ventilator and assist in connecting to the patient.	Action View
# 7	Learning outcome 2	Competency Set up and perform pre-use checks on nitric oxide delivery system and assist in connecting to the patient.	Action View
# 8	Learning outcome 2	Competency Set up and perform pre-use checks on anaesthetic agent delivery system and assist in connecting to the patient.	Action View
# 9	Learning outcome 2	Competency Set up and perform pre-use checks on Heliox delivery system and assist in connecting to the patient.	Action View
# 10	Learning outcome 3	Competency Diagnose patient/ventilator interactions using pressure/flow/volume waveforms.	Action View
# 11	Learning outcome 3	Competency Diagnose patient/ventilator interactions using end tidal carbon dioxide waveforms.	Action View
# 12	Learning outcome 3	Competency Set up and perform pre-use checks on multi-gas monitoring system and assist in connecting to the patient ventilator circuit.	Action View
# 13	Learning outcome 4	Competency Set up and prime a continuous renal replacement therapy (CRRT) circuit with reference to aseptic non-touch technique (ANTT) techniques.	Action View
# 14	Learning outcome 4	Competency Evaluate appropriate anticoagulation technique.	Action View
# 15	Learning outcome 5	Competency Assist in set-up and pre-use check of intra-aortic balloon pumps (IABP).	Action View
# 16	Learning outcome 5	Competency Evaluate appropriate mode/settings available during IABP therapy	Action View
# 17	Learning outcome 6	Competency Set up and perform pre-use checks on syringe driver.	Action View

Assessments

You must complete:

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

Prepare HFOV ventilator ready for patient use. Perform pre use checks and verify circuit setup.	DOPS
Prepare IABP ready for patient use. Perform pre use checks.	DOPS
Prepare the equipment required in order to administer Nitric oxide safely to a ventilated patient.	DOPS
Explain to HCP the importance of respiratory mechanics manoeuvres on a ventilated patient.	OCE
Demonstrate to HCP the auto PEEP, Intrinsic PEEP manoeuvre on ventilated patient, including explanation of relevance to ventilator settings.	OCE

Learning outcomes

The trainee should produce evidence of completion of basic or intermediate life support training before undertaking any of the learning outcomes.

1. Perform the selection of the appropriate mode and pattern of ventilation with respect to the patient’s sedation level and lung pathology/pathophysiology, diagnosing common problems associated with ventilator testing and application.
2. Set up, apply and manage a range of adjunct ventilation therapies, such as high frequency oscillatory ventilation (HFOV), high frequency jet ventilation (HFJV), nitric oxide therapy (NO), anaesthetic agent delivery in critical care and Heliox applications.
3. Interpret and apply the monitoring techniques available on high specification ventilators with respect to the ventilation settings.
4. Perform and manage Continuous Renal Replacement Therapy (CRRT) for a range of pathologies safely in accordance with current guidelines.
5. Set up and operate an intra-aortic balloon pump (IABP) with reference to safety, risk management and therapeutic effects.
6. Set up and manage a range of syringe drivers within the critical care environment.

Learning outcomes

1. Describe the clinical signs associated with critical illness, their relative importance and interpretation, and the relevance of prior health status in determining risk of critical illness and outcomes
2. Describe the effects and acute complications of severe trauma on organs and organ systems.
3. Describe the anatomy, physiology, pathophysiology and co-morbidities underlying typical conditions affecting patients admitted to an intensive care environment, including heart disease and common congenital cardiac disorders.
4. Describe the technology, techniques, equipment, preparation and precautions required for safe management of the patient airway.
5. Describe the common modes and patterns of ventilation and indications for ventilatory support, and justify the selection relative to individual patient clinical need.
6. Explain the principles of use of a range of non-invasive ventilatory therapies, including indications, limitations and techniques, modes of ventilation and the need for humidification and use of nebulisers.
7. Describe a range of advanced therapies and relate these to the patient’s clinical condition and the underpinning evidence base.
8. Explain the principles, application and maintenance of volumetric and syringe-driven infusion devices.
9. Describe the principles and application of intra-aortic balloon pump (IABP) therapy, including the physiological effects and the underpinning evidence base.
10. Explain the causes of cardiorespiratory arrest, identification of patients at risk and corrective treatment of reversible causes.
11. Describe peri-arrest arrhythmias and the principles of their management.
12. Describe the current basic life support UK Resuscitation Council Guidelines, the underpinning evidence base and justify the indications for not commencing resuscitation or ceasing an initiated attempt.
13. Recognise the relevant ethical, legal, religious and cultural aspects of end of life care and the process of withholding or withdrawing treatment.
14. Discuss the legal and ethical principles underpinning organ donation and transplantation.
15. Critically evaluate the role of the critical care scientist in the current and future care and management of the critically ill.

Indicative content

Clinical signs associated with critical illness

• Definition of critical illness
• Cardinal features of critical illness
  • Appearance
  • Neurological
  • Respiratory
  • Cardiovascular

Effects and acute complications of severe trauma on organs and organ systems

• Respiratory: thoracic trauma; acute lung injury; tension pneumothorax
• Cardiovascular: hypovolaemic shock; cardiac tamponade
• Renal: acute renal failure; rhabdomyolysis
• Neurological: altered consciousness; traumatic brain injury; post-anoxic brain injury; coup and contra-coup
• Injuries: extradural and subdural haematomas; intracranial haemorrhage and infarction; spinal cord injury
• Gastrointestinal: abdominal trauma; abdominal tamponade; rupture of liver or spleen
• Musculoskeletal system: soft tissue injury; short-term complications of fractures; fat embolism; crush injury and compartment syndromes
• Maxillofacial injuries

Typical conditions affecting patients admitted to an intensive care environment

• Circulatory failure, including hypovolamic shock
• Acute kidney injury
• Acute liver failure
• Neurological impairment, including epilepsy
• Acute gastrointestinal failure
• Acute lung injury syndromes, including acute respiratory distress syndrome
• Sepsis
• Intoxication with drugs or environmental toxins
• Poison (accidental and non-accidental)
• Renal failure
• Liver failure
• Multi-organ failure
• Trauma, including burn/dermal injury, spinal, chest
• Major surgery, for example hepatobilary and pancreas, maxillofacial
• Hypothermia
• Pulmonary oedema

Causes, recognition and management of:

• Acute chest pain
• Tachypnoea and dyspnoea
• Upper and lower airway obstruction
• Pulmonary oedema
• Pneumothorax (simple and tension)
• Hypoxaemia
• Hypotension
• Shock states
• Anaphylactic and anaphylactoid reactions
• Hypertensive emergencies
• Acute confusional states and altered consciousness
• Acute seizures/convulsions
• Oliguria and anuria
• Acute disturbances in thermoregulation

Advanced mechanical ventilation techniques

• Pressure-controlled ventilation
• Volume-controlled ventilation
• Pressure-regulated volume-controlled (PRVC) and autoflow
• Optimisation of pressure end expiratory pressure (PEEP)/FiO2 (concentration of inspired oxygen)
• Pressure/flow waveform interpretation
• Flow/volume, pressure volume loops
• Weaning strategies
• High frequency jet ventilation (HFJV), high frequency oscillatory ventilation (HFOV), nitrous oxide, Heliox
• Nebulisation therapies
• extracorporeal membrane oxygenation (ECMO)
• CO2 removal (Novalung)

Humidifiers

• Humidity (absolute and dewpoint)
• Under humidification
• Over humidification
• Cilliary movement and lung compliance
• Hot and cold humidification
• Importance of droplet size

 

Principles, application and maintenance of volumetric and syringe- driven infusion devices

• Choice of device
• Gravity controllers (drip rate controllers, flow status systems)
• Volumetric pumps
  • Peristaltic
  • Dedicated cassette
• Syringe pumps
• Patient-controlled analgesia pumps (PCA)
• Anaesthesia pumps
• Ambulatory pumps
• Types of incidents involving infusion pumps, including extravasation
• Piggyback infusions
• Pump management
• Selection and procurement
• Reporting adverse incidents
• Preparation for use
• Maintenance and repair
• Training of staff

 

Measurement of capillary reflex time

• Indications
• Limitations
• Guidelines

Intra-aortic balloon pump (IABP) therapy

• Basic principles of counter pulsation
• Physiological effects of IABP therapy
  • Myocardial oxygen supply and demand
  • Coronary perfusion
  • Renal function
  • Haematological effects
• Indications
  • Acute myocardial infarction
  • Ventricular arrhythmias
  • Cardiogenic shock
  • Unstable angina
  • Refractory ventricular failure
  • Cardiac surgery
• Contraindications
• Technique of insertion and operation
• Anticoagulation
• Complications

 

Causes of cardiorespiratory arrest

• Airway obstruction
• Breathing inadequacy
• Cardiac abnormalities
  • Acute coronary syndromes
• Warning signs and symptoms
• Early recognition

 

Peri-arrest arrhythmias

• Bradycardia
• Broad complex tachycardia
• Atrial fibrillation
• Narrow complex tachycardia

 

Principles and ethical issues with respect to organ donation and transplantation

Activities

• Observe the care and treatment of a range of patients within a critical care environment and discuss the procedures to manage risk to patients requiring critical care, including the underpinning evidence base with your training officer.
• Work within a range of theatres where patients who may develop or have a critical illness are treated, observing the work of the anaesthetic team and theatre team and reflect on the role of the multidisciplinary team in the care of the critically ill patient.
• Observe the practice of open heart surgery requiring cardiopulmonary bypass and discuss the principles and practice of clinical perfusion with a member of the clinical perfusion team.
• Observe the care of paediatric patients in a critical care environment and reflect on how this care may differ from that needed by adult patients.
• Attend a meeting at which the outcome of a clinical audit, research, innovation, or service development is presented and discuss with your training supervisor how evidence-based practice is implemented with respect to critical care.