Knowledge

Clinical signs associated with critical illness, their relative importance and interpretation
Surface anatomy: structures in the antecubital fossa; large veins and anterior triangle of the neck; large veins of the leg and femoral triangle; arteries of the arms and legs
Importance and principles of obtaining an accurate history of the current condition, comorbidities and previous health status using appropriate sources of information
Interpretation of information from monitoring devices, and identification of common causes of error; principles of monitoring trends of change and their significance
Principles of ECG monitoring (heart rate, rhythm, conduction, ST segment change & QT interval) - indications, limitations and techniques. Advantages and disadvantages of different lead configurations
Indications for and basic interpretation of chest radiographs: range of normal features on a chest x-ray; collapse, consolidation, infiltrates (including ALI/ARDS), pneumothorax, pleural effusion, pericardial effusion, position of cannulae, tubes or foreign bodies, airway compression, cardiac silhouette, mediastinal masses
Sources and methods of obtaining clinical information
Recognition of life threatening changes in physiological parameters
Effect of projection, position, penetration and other factors on the image quality
Relevance of prior health status in determining risk of critical illness and outcomes
Principles of aseptic technique and aseptic handling of invasive medical devices
Hazards of inappropriate monitoring including misuse of alarms; principles of disconnection monitors
Significance and impact of co-morbid disease on the presentation of acute illness
Indications for and the selection of suitable methods of monitoring or investigation taking into account their accuracy, convenience, reliability, safety, cost and relevance to the patient's condition.
Impact of drug therapy on organ-system function
Sensitivity and specificity of the investigation as related to a specific disease
Methods and routes of obtaining samples - associated indications and complications
Principles of haemodynamic monitoring - invasive & non invasive methods, indications & limitations, physiological parameters and waveform interpretation
Appropriate use of laboratory tests to confirm or refute a clinical diagnosis
Universal precautions and preventative infection control techniques (hand washing, gloves, protective clothing, sharps disposal etc.)
Pre-analytical errors of arterial blood gas sampling (choice of sample site, sampling device, heparin, mixing, storage and transport)
Basic interpretation of radiological investigations:
Indications, limitations and basic interpretation of laboratory investigations of blood and other body fluids ( e.g urine, CSF, pleural and ascitic fluids):
Interpretation of, relationships between, sources of error and limitations of measured and derived cardiovascular variables including pressure, flow, volume and gas transport
Principles, indications, limitations and basic interpretation of:
Invasive & non-invasive systems available for measuring cardiac output and derived haemodynamic variables, the principles involved and the type and site of placement of the monitoring device
Principles, indications and limitations of pulse oximetry
Principles, including indications, limitations and therapeutic modalities of basic radiological methods, CT scanning, MRI, ultrasound, angiography and radionucleotide studies in the critically ill patient
Principles of monitoring ventilation - significance of respiratory rate, tidal volume, minute volume, mean, peak, end expiratory and plateau pressure, intrinsic and extrinsic PEEP, inspired oxygen concentration, arterial blood gas and acid base status; relationship between mode of ventilation and choice of parameters monitored; airflow and airway pressure waveforms
Risks to patient and staff of radiological procedures and precautions to minimise risk
Physical principles, indications and limitations of end tidal CO2 monitoring, and relationship between end tidal CO2 and arterial pCO2 in various clinical circumstances
Methods for assessing pain and sedation
Methods for assessing neurological function e.g. Glasgow Coma Scale
Systems available for intracranial pressure monitoring - indications, principles, type and site of placement of the monitoring device, data collection and trouble-shooting
Indications and techniques of jugular bulb oximetry

Skills & Behaviours

Obtain blood gas samples using aseptic techniques; interpret data from arterial, central venous or mixed venous samples
Identify deviations from normal range and interpret these in the context of the clinical circumstances
Interpret chest x-rays in a variety of clinical contexts
Professional and reassuring approach - generates confidence and trust in patients and their relatives
Examine patients, elicit and interpret clinical signs (or relevant absence of clinical signs) in the ICU environment
Differentiate real change from artefact & respond appropriately
Obtain relevant information from the patient, relatives and other secondary sources
Communicate effectively with radiological colleagues to plan, perform and interpret test results
Listen effectively
Obtain blood cultures using aseptic techniques
Acquire, interpret, synthesize, record, and communicate (written and verbal) clinical information
Develop a working, and limited differential diagnosis based on presenting clinical features
In emergency situations, confirm or refute early diagnoses before data collection / analysis is complete - make contingency plans based on these diagnoses to combat further threats to the patient's life
Integrate clinical findings with results of investigations
Recognise impending organ system dysfunction
Communicate and collaborate effectively with all laboratory staff
Integrate history with clinical examination to create a diagnostic and therapeutic plan
Order and prioritise appropriate investigations
Assemble clinical and laboratory data, logically compare all potential solutions to the patient's problems, prioritise them and establish a clinical management plan
Evaluate benefits and risks related to specific investigations
Interpret laboratory results in the context of the patient's condition
Confirm adequate oxygenation and control of PaCO2 and pH
Identify abnormalities requiring urgent intervention
Monitor vital physiological functions as indicated
Recognise significant changes and the need for repeated testing (ie. that a single normal result is not as significant as identifying trends of change by repeated testing where indicated)
Obtain and accurately record data from monitors
Document investigations undertaken, results and action taken
Undertake further consultation / investigation when indicated
Set and interpret data from ventilator alarms
Recognise and rapidly respond to adverse trends in monitored parameters
Recognise patterns in trends - early diagnosis and outcome prediction
Review the need for continued monitoring regularly
Use emergency monitoring equipment
Obtain and interpret data from:

Set monitor alarms appropriately
Interpret data from scoring or scaling systems to assess pain and sedation
Assess and document Glasgow Coma Scale (GCS)
Recognise changes in intracranial and cerebral perfusion pressure which are life threatening
Lead, delegate and supervise others appropriately according to experience and role

Attitudes

Consults, communicates and collaborates effectively with patients, relatives and the health care team
Promotes respect for patient privacy, dignity and confidentiality
Avoids extensive invasive procedures or monitoring which can not be adequately interpreted at the bedside
Minimises patient discomfort in relation to monitoring devices
Responds rapidly to acute changes in monitored variables
Ensures safe and appropriate use of equipment
Supports other staff in the correct use of devices
Considers patient comfort during procedures / investigations
Avoids unnecessary tests
Demonstrates compassionate care of patients and relatives
Desire to minimise patient distress
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)


Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.