Surgical Critical Care

Critical Care Curriculum

How to use this page: 

Below you will find a list of major topics you should master during your ICU rotation. Each major category, listed in bold blue serve as links to pages with education resources on each topic. 

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​Traumatic Brain Injury

Objectives

• Know how to determine a patients Glascow Coma Score

• Understand the pathophysiology of primary and secondary brain injury

• Be able to list the treatment goals for severe traumatic brain injuries

• Understand the Monroe - Kelly Statement

• Know how to calculate a cerebral perfusion pressure

• Explain "Diffuse Axonal Injury" a.k.a. DAI

• Understand the different types of monitoring devices used in severe TBI

• Be familar with treatment options for seizures

• Be able to recognize and treat

  • Paroxysmal Sympathetic Hyperactivity

  • Central Diabetes Insipidus

  • Cerebral Salt wasting

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Brain Death

Objectives

• What does 'brain death' mean

• Know the legal definition of brain death in California​

• Review and be familar with the WCHGH brain death protocol

• Understand how to perform a brain death exam

• Be familiar for the process of Organ Donor referral

  • List criteria for organ donation​

  • Understand the different types of organ donation

• Describe how to support patient physiology in the setting of brain death

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Other causes of neurologic dysfunction:

Delirium

Alcohol Withdrawal Syndrome

Encephalopathies

​Objectives

• Identify the types of delirium seen in the ICU

• Propose preventive measures to minimize delirium in ICU patients

• Describe therapies for delirium

• Understand the timing for alcohol withdrawal syndrome

• Describe therapies used in prevention and treatment of alcohol withdrawal syndrome

• Identify causes of encephalopathy in critically ill patients​​

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Spinal Cord Injury

Objectives

• Be familiar with the Spinal Cord Injury Guidelines

• Understand purpose of and describe how to complete an ASIA form 

• Describe the difference between 'Neurogenic' and 'Spinal' shock

• Autonomic dysreflexia

• Special risks in spinal cord injured patients

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Cardiovascular Physiology

Objectives​

• Explain the components of heart physiology

  • Pre-load​

  • After load

  • Cardiac Output

  • Cardiac cycle

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Cardiovascular Pathophysiology

• Understand diagnosis and management of arrhythmias​

• Know types of antiarrhythmics

  • Indication for use\​

  • Mechanism of Action

  • Risks

• Know common antihypertensives

  • Indication for use​

  • Mechanism of Action

  • Risks

• Identify pressor agents

  • Indication for use​

  • Mechanism of action

  • Risks

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Other heart disorders

• Know immediate steps in managing cardiac arrest

• Understand the types of Cardiac Failure

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Basic Pulmonary Mechanics

Objectives

• Understand pulmonary physiology as it relates to the anatomy of the lungs

• Be familiar with forms of pulmonary pathophysiology commonly seen in surgical intensive care patients

• Be able to choose lung protective ventilator strategies in patients with acute lung injury

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Components of gas exchange physiology​​

Objectives

• Understand the components of gas exchange and how they can be supported with strategic ventilator settings

  • Oxygenation​

  • Ventilation

  • Minute ventilation

  • A - a gradient

  • P/F ratio

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ABG interpretation 

Objectives

• Understand the components of arterial blood gas components

• Be able to interpret ABG data

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Ventilator Management

Objectives

• Be familiar with ventilator modes, settings and terminology

• Understand potential complications for each ventilator mode

• Exhibit ability to trouble shoot ventilator sources for hypoxemia

• Weaning  guidelines

• Identify indications for Intubation / Extubation

• Know advanced ventilator techniques for patients with acute lung injury

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Respiratory Failure & Pulmonary Pathologic States

Objectives

• Understand diagnosis and treatment of

  • Pulmonary Embolism

  • Acute Lung Injury

  • Acute Respiratory Distress Syndrome

  • Pneumonia

  • Pulmonary contusions

  • Bronchopleural fistula

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Sedation and Analgesia

Objectives

• List indications for using sedation and analgesia ​

• Be able to list common medications and interventions used in multi-modal pain regimens

  • Describe indications for use​

  • Understand Mechanims of Action

  • Identify specific contraindcations 

  • Know risks of medication / modality

• Be able to list common sedatives used in the intensive care unit

  • Describe indications for use​

  • Understand Mechanims of Action

  • Identify specific contraindcations 

  • Know risks of medication / modality

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Shock​ & Resuscitation

Objectives

• Know the definition of Shock

• Describe causes of shock

• Know how to diagnose shock

• Describe the treatment for specific forms of shock

  • Anaphylactic

  • Septic​

  • Hemorrhagic

  • Hypovolemic

  • Cardiogenic

  • Neurogenic

• Describe how to assess a patient's fluid status during resuscitation

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Blood and Coagulopathies

​Objectives

• Identify common causes of coagulopathy in injured or critically ill surgical patients

• List common reasons for patients to be hypercoagulable

• Understand the mechanism of action for drugs used for anticoagulation

• What are the reversal agents for commonly used anticoagulants

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Gastrointestinal disorders

Objectives

• Be able to diagnose and treat the following GI disorders in the ICU

  • Abdominal Compartment Syndrome

  • Diarrhea

  • Ileus​

  • Bowel obstruction

  • Entero-atmospheric fistula

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Nutritional assessment and treatment in the ICU

Objectives

• Know when / what nutrition is indicated 

• Understand risk and benefits of different types of nutrition

• Know how to assess a patient's nutritional status

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Renal

Objectives

• Know how to determine

  • normovolemia

  • hypovolemia

  • hypervolemia

• Identify signs of acute renal insufficiency and acute renal failure

• Determine appropriate interventions for acute renal insufficiency and acute renal failure

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Endocrine Dysfunction

Objectives​

• Identify the main organs involved in endocrine pathology in the intensive care setting

• Understand the importance of glucose control in critically ill patients

• Be able to identify signs and symptoms of adrenal insufficiency

•  Know how to diagnose and treat thyroid storm

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Electrolyte Abnormalities and Acid / Base status

Objectives

• Understand the causes of and treatments for the following electrolyte abnormalities

  • Hyperkalemia / Hypokalemia

  • Hypernatremia / Hyponatremia​

  • Hyperchloremia / Hypochloremia

• Understand the causes of and treatments for the following acid / base abnormalities

  • Acute respiratory acidosis and alkalosis​

  • Chronic respiratory acidosis and alkalosis

  • Acute metabolic acidosis and alkalosis

  • Chronic metabolic acidosis and alkalosis

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Hepatic disorders in the Surgical ICU

• Understand causes and management of acute hepatic failure

• Understand management of patients with advanced cirrhosis

• Describe how to diagnose and treat hepato-renal syndrome

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Medical Ethics in the Intensive Care Setting​​​​​​

Objectives

• List the four major tenents of medical ethics

• Describe a scenario where each ethical principle can be applied 

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