Universitat Internacional de Catalunya
Critical Medicine: Protocols in Immediate Action
Teaching staff
Professor responsible for the subject: - Dr. M. Dolores Bosque mdbosque@quironsalud.es / delbosque@uic.es
Associate professors: - Dr. Olga Rubio orubio@althaia.cat / bl073152@uic.es - Dr. Melcior Martínez melcior.martinez@quironsalud.es
Internship professors:
H. Granollers:
- Dr. Pablo Velasco pvelasco@fphag.org
- Dra. Dorian Salazar dysalazar@fphag.org
H. Universitari General de Catalunya:
- Dra. M. Dolores Bosque mdbosque@quironsalud.es
Introduction
Intensive or Critical Medicine is a medical specialty in Spain for over 40 years being devoted to the treatment of patients with life-threatening illnesses acutely, but reversible. This will serve patients in specific areas of the hospital where it accumulates a number of technical and human resources far superior to any other.
The treatments used in support, and often temporarily replace the function of vital organs including mechanical ventilators, pacemakers, dialyzers, parenteral nutrition, central catheters, ....
This specialty focuses intensely on pathophysiological approach, while medical actions are reinforced by the immediate effect of most treatments, both to deepen the strategy decided, to refocus the whole process when evolution is unfavorable.
This peculiarity also explains the high presence of clinical research in this area. As an example, in medical research while Spain is between the 9th and 10th in the world (according to other indicators, economic, industrial, ...) in critical care we are in 5th place worldwide.
Currently it requires the involvement of intensivists not only in the ICU, but also in supporting patients suddenly unstable in other areas such as emergency departments, hospital wards, day hospitals, and even pre-hospital care.
Pre-course requirements
The student must have advanced knowledge of various generic pathological situations that occur in the body.
Objectives
Acquire a fundamental knowledge of the critical care and have the ability to immediately assess and treat serious or life situations most common serious. Understand and recognize the effects, mechanisms and manifestations of the disease on the structure and function of the human body.
· Acquire basic life support skills, including diagnosis, treatment of shock and basic skills related procedure.
· Master the skills in advanced life support.
· Acquiring the ability to differentiate and treat common serious problems.
· Learn the severity criteria of the different diseases in ICU, ER and hospital wards.
· Learn the severe multiple trauma patient management, including initial resuscitation and subsequent management.
· Acquire mastery of basic skills of procedures such as airway management and venous access.
· Learn to prioritize care to patients with more severe problems.
Competences/Learning outcomes of the degree programme
- 07 - Understand and recognise normal structure and function of the human body at the molecular, cellular, tissue, and organ and systemetic levels, at different stages of life and in both sexes.
- 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
- 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
- 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
Learning outcomes of the subject
· Argue the importance of history and examination data to assigned cases.
· Develop a differential diagnosis in a case assigned. Prioritize accurate diagnostic tests based on the severity and the expected performance.
· Argue indications for surgery in selected cases.
· Perform initial ICU treatment plan according to pathology the patient.
· Correctly apply basic resuscitation techniques (fluids, oxygen, vasoactive drugs).
Syllabus
Practices: There will be 10 days of clinical practice (2 weeks) in the Intensive Medicine Service, from 8:00 a.m. to 1:00 p.m. (H: Granollers) and 8:30 to 13:30 (HUGC) in order to learn how to manage different clinical situations in a practical way. Tutored by a specialist in Intensive Medicine, they will assist patients, participate in specific ICU techniques and provide information to patients and their families. In total, the classes and practices represent a total of 59 hours (9 hours of classes + 50 hours of practices). The rest of the hours up to 2 ECTS (=60 h) will be the student's personal work. In addition, students will be invited to be able to carry out, in their free time, guards in the Intensive Medicine service and depending on the demand and conditioned to being able to schedule it in the Extra-hospital Emergency Service or attend surgery for a neurocritical or cardiac patient.
Teaching and learning activities
In person
The master class is the scenario in which a teacher transmits knowledge in a classroom to the entire group of students. It will be based on the description of the basic information of each topic, and it continues with three clinical cases with a similar presentation that reach the differential diagnosis and specific treatment.
During hospital internships, the student will rotate with a doctor whom they will accompany during the care of critical patients in the Intensive Medicine Service of the assigned hospital (Hospital Universitari General de Catalunya and Hospital de Granollers), will participate in the service's clinical sessions and will be present in clinical information to families. They will also learn the basic techniques of the ICU (central venous access, intubation, temporary pacemaker, continuous hemodialysis, fiberoptic bronchoscopy, echocardiography, transcranial echo Doppler, pleural drainage puncture, etc.)
Evaluation systems and criteria
In person
The evaluation will be carried out based on the results of: 1. Final theoretical test-type exam with multiple options but only one correct, with a negative score for errors. The questions will be made about contents addressed in classes and practices. 2. Student attitude during internships in the Intensive Medicine Service 3. Power Point presentation on the last day of the internship on a topic of clinical interest learned during the internship (10-15 minute presentation) The final grade will result from the sum of the grade in the final theoretical exam (70% of the grade) and the grade obtained during the practices (30% of the grade). A negative qualification of the practical part will prevent the passing of the subject.
EVALUATION CRITERIA of practices Final presentation: The chosen topic is of interest and clear relevance The content of the presentation is well structured The content is well documented (the sources of information used are of high quality) Information is well organized, clear and logical You have a good command of the subject You communicate clearly and your tone of voice is appropriate Maintains the audience's attention and interest throughout the presentation Adheres to the set time The audiovisual resources and/or support material do not present errors in form and/or content Provides properly referenced bibliography Attitude during practice: Show interest in learning Integration in the healthcare team Punctuality, daily attendance
Bibliography and resources
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Irwin & Rippe's Manual of Intensive Care Medicine Sixth Edition, by Richard S. Irwin MD, Craig Lilly MD, James M. Rippe MD. Editorial: Lippincott Williams and Wilkins
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The Washington Manual of Critical Care (Lippincott Manual) Second, Revised Edition, by Marin Kollef MD, Warren Isakow MD. Editorial: Lippincott Williams and Wilkins