Knowledge

Pathophysiology, diagnosis and management of commonly encountered acute and chronic medical conditions including:
Respiratory disorders: the unprotected airway; pneumonia, lung or lobar collapse, asthma, chronic obstructive airways disease, pulmonary oedema, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and their causative factors; pulmonary haemorrhage, pulmonary embolus, pleural effusion, pneumothorax (simple and tension); upper and lower airway obstruction including epiglottitis, respiratory muscle disorders; pulmonary fibrosis; ulmonary thrombo-embolic disease
Cardiovascular disorders: shock states (anaphylactic, cardiogenic, hypovolaemic, septic); crescendo / unstable / chronic angina; acute myocardial infarction; left ventricular failure; chronic heart failure; cardiomyopathies; valvular heart disease and prosthetic valves; vaso-occlusive diseases; pulmonary hypertension; right ventricular failure; cor pulmonale; malignant hypertension; cardiac tamponade; common arrhythmias and conduction disturbances, pacing box failure; peripheral vascular disease
Neurological disorders: acute confusional states and coma; post-anoxic brain damage; intracranial haemorrhage and infarction; sub-arachnoid haemorrhage; cerebro-vascular accidents (CVA / stroke); convulsions and status epilepticus; meningitis and encephalitis; medical causes of raised intracranial pressure; acute neuromuscular diseases causing respiratory difficulty (e.g. Guillain-Barre, myasthenia gravis, malignant hyperpyrexia); critical illness polyneuropathy, motor neuropathy and myopathy; cerebro-vascular accidents (CVA / stroke); dementia
Gastrointestinal disorders: peptic/stress ulceration; upper GI haemorrhage; diarrhoea and vomiting; pancreatitis; cholecystitis; jaundice; acute and chronic liver failure; fulminant hepatic failure; paracetamol (acetaminophen)-induced liver injury;cirrhosis; inflammatory bowel diseases; peritonitis; ascites; mesenteric infarction; perforated viscus; bowel obstruction & pseudo-obstruction; abdominal trauma; intra-abdominal hypertension & compartment syndrome; short-bowel syndrome; rupture of liver or spleen.
Haematological and oncological disorders: disseminated intravascular coagulation (DIC) and other coagulation disorders, hemolytic syndromes, acute and chronic anemia, immune disorders; lymphoproliferative disorders. High risk groups: the immunosuppressed or immunoincompetent patient, chemotherapy, agranulocytosis and bone marrow transplant patients. Massive blood transfusion. Malignancy including complications of chemotherapy and radiotherapy
Investigation of impaired organ function
Signs, symptoms and causes of renal failure (acute / chronic / acute on chronic) and indications for intervention
Signs and symptoms of acute airway insufficiency and acute respiratory failure, and indications for intervention
Pathogenesis, definitions and diagnostic criteria of sepsis, severe sepsis, septic shock and systemic inflammatory response syndrome (SIRS)
Signs and symptoms of acute intoxication associated with common intoxicants
Signs and symptoms of acute liver failure and assessment of severity
Distinguishing features of acute versus chronic renal failure and implications for management
Causes of respiratory failure, their prevention and management
Occult indicators of sepsis
Multisystem effects of acute intoxication and implications for clinical management
Cardiopulmonary resuscitation of the pregnant patient
Causes and complications of acute and acute-on-chronic liver failure, their prevention and management
Causes and complications of renal failure - methods to prevent or treat these
Causes, recognition and management of sepsis-induced organ dysfunction; multisystem effects of sepsis and their impact on clinical management
General supportive therapy and specific antidotes pertinent to individual intoxicants
Pathophysiology, identification and management of peripartum complications: pre-eclampsia and eclampsia; HELLP syndrome; amniotic fluid embolism; ante-partum and post-partum haemorrhage; ectopic pregnancy; septic abortion
Investigation of impaired renal function
Specific management of poisoning with aspirin, paracetamol/acetaminophen, paraquat, carbon monoxide, alcohol, ecstasy, tricyclic and quadricyclic antidepressants
Risks and avoidance of pulmonary aspiration in pregnant patients
Renal and genito-urinary disorders: urological sepsis; acute renal failure; chronic renal failure; renal manifestations of systemic disease including vasculitides; nephrotoxic drugs and monitoring; rhabdomyolysis
Indications for urgent imaging of the brain and neurosurgical consultation
Strategies to reduce absorption and enhance elimination (haemodialysis, haemoperfusion, gastric lavage and charcoal therapy)
Methods of avoiding aorto-caval compression
Complications of specific therapies, their incidence and management
Pharmacology of common intoxicants
Infections: pyrexia and hypothermia; organ-specific signs of infection including haematogenous (venous catheter-related, endocarditis, meningococcal disease), urological, pulmonary, abdominal (peritonitis, diarrhoea), skeletal (septic arthritis) soft tissue and neurological. Pyometra. Septic abortion. Organisms causing specific infections: Gram positive and Gram negative bacteria, fungi, protozoa, viruses; nosocomial infections
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
Metabolic disorders: electrolyte disorders; acid-base disorders; fluid-balance disorders; thermoregulation and associated disorders
Indications for and methods of invasive and non-invasive mechanical ventilation
Endocrine disorders: critical illness-induced hyperglycaemia; diabetes mellitus; over- and under-activity of thyroid; adrenal and pituitary disorders; sepsis-induced relative adrenal insufficiency; endocrine emergencies
Range of therapeutic interventions available to support organ function and treat the underlying causes
Causes and consequences of decompensation in chronic organ failure; diagnosis and management of acute-on-chronic organ failure
Modes of mechanical ventilation - indications, contraindications & expected results of each mode (CMV, IRV, PRVC, HFOV, SIMV, PS, CPAP, BiPAP, NIV)
Indications and complications of hyperbaric oxygenation
Treatment algorithms for common medical emergencies
Cardiopulmonary resuscitation
Initial set-up and modification of ventilator settings according to the condition or response of the patient
Definitive / long term management of commonly encountered acute medical conditions
Impact of occupational and environmental exposures, socio-economic factors, and life style factors on critical illness
Pathogenesis of multiple organ dysfunction (MODS) and the inflammatory response in relation to organ system dysfunction
Indications, complications and selection of renal replacement therapies (continuous and intermittent)
Factors and therapies which may influence intra-abdominal pressure; etiology and management of raised intra-abdominal pressure
Potential adverse effects and complications of respiratory support and methods to minimise these
Diagnosis and management of other acute medical conditions until appropriate specialist assistance is available
Multisystem effects of acute medical conditions and implications for clinical management
Nephrotoxic drugs and adjustment of drug doses in renal impairment/failure
Detection and management of haemo/pneumothorax (simple and tension)
Evidence based guidelines: sepsis care bundles - rationale and indications; principles of early goal-directed therapy
Indications and contraindications for treatment; circumstances when treatment is unnecessary or futile
Supportive therapy for the failing liver including extracorporeal liver support and indications for emergency liver transplantation
Lung protective ventilation for acute lung injury (ALI)
Indications for and basic interpretation of drug levels in blood or plasma
Therapies available for the treatment of commonly encountered medical conditions, their efficacy and potential side-effects
Methods for assessing neurological function e.g. Glasgow Coma Scale
Etiology and management of raised intracranial pressure (ICP)
Urinary catheterisation techniques: transurethral and suprapubic
Pharmacological and non-pharmacological adjunct therapies for ALI
Concept of risk : benefit ratio and cost effectiveness of therapies
Systems available for intracranial pressure monitoring - indications, principles, type and site of placement of the monitoring device, data collection and trouble-shooting
Principles of weaning from mechanical ventilation and factors which may inhibit weaning
Complications of the disease processes; effects of disease and its treatments on other organ systems
Techniques for effective fluid resuscitation
Cerebral spinal fluid (CSF) drainage for raised ICP
Principles of extra-corporeal membrane oxygenation (ECMO)
Effects of concomitant treatment and/or co-morbid conditions on an individual patient's response to treatment
Principles of management of closed head injury
Principles of cerebral perfusion pressure, cerebral oxygenation and the methods by which they may be optimised
Principles of outcome prediction / prognostic indicators and treatment intensity scales; limitations of scoring systems in predicting individual patient outcome
Coup and contra-coup injuries
Factors and therapies which may influence intracranial and cerebral perfusion pressure
Long term effects of acute medical conditions and late complications
Methods of preventing the 'second insult' to the brain
Principles of measurement of jugular venous saturation, cerebral Doppler velocities and cerebral blood flow.
Risk factors, recognition and assessment of single or multiple organ failure
Safe use of therapies which modify the inflammatory response
Management of vasospasm
Identification of unexpected concurrent pregnancy in a critically ill woman
Hepatoxic drugs and adjustment of drug doses in hepatic impairment / failure
Awareness of the psychological impact of separation on the family
Application of techniques to treat or induce hypo/hyperthermia
Principles of blood glucose control: indications, methods, monitoring of safety & efficacy
Principles and techniques for insertion of gastro-oesophageal balloon tamponade tube (e.g. Sengstaken-Blakemore)
Indications for transcutaneous & transjugular liver biopsies and transjugular intrahepatic portosystemic shunt (TIPSS)
Prognostic implications of multiple systems dysfunction or failure
Services available to patients and families to provide emotional or psychiatric support

Skills & Behaviours

Measure and interpret haemodynamic variables (including derived variables)
Identify and evaluate requirements for continuation of chronic treatments during and after the acute illness
Optimise myocardial function
Assess, predict and manage circulatory shock
Evaluate the impact of chronic disease and prior health on outcomes
Take chronic health factors into account when determining suitability for intensive care
Identify patients at risk of developing renal failure
Identify and avoid factors contributing to impaired renal function
Implement emergency airway management, oxygen therapy and ventilation as indicated
Demonstrate emergency relief of tension pneumothorax
Acquire, interpret, synthesize, record, and communicate (written and verbal) clinical information
Develop a working, and limited differential diagnosis based on presenting clinical features
Recognise and diagnose commonly encountered acute medical conditions (according to national case mix)
Recognise impending organ system dysfunction
Order and prioritise appropriate investigations
Identify patients at risk of acute liver failure
Establish a management plan based on clinical and laboratory information
Interpret laboratory tests of liver function
Critically appraise the evidence for and against specific therapeutic interventions or treatments
Prioritise therapy according to the patient's needs
Resuscitate a patient with septic shock using appropriate monitoring, fluid therapy and vasoactive agents
Consider potential interactions when prescribing drugs & therapies
Identify and manage chronic co-morbid disease
Define targets of therapy and review efficacy at regular intervals
Select the appropriate type and mode of ventilation for an individual patient
Consider modifying diagnosis and/or therapy if goals are not achieved
Undertake or assist in the insertion and maintenance of an intracranial pressure monitor
Lead, delegate and supervise others appropriately according to experience and role
Recognise and manage emergencies; seek assistance appropriately
Examine and plan care for the confused patient
Recognise changes in intracranial and cerebral perfusion pressure which are life threatening
Assess and document Glasgow Coma Scale (GCS)
Take prompt action to reduce acutely elevated intracranial pressure
Plan, implement, review and adapt lung protective approach during mechanical ventilation
Manage cardiorespiratory physiology to minimise rises in intracranial pressure
Plan, perform and review lung recruitment manoeuvres
Identify and manage coagulopathies
Prevent, identify and manage hyper / hypoglycaemia
Prevent, identify and treat hyponatraemia
Liaise with obstetric and midwifery services
Manage pregnancy induced hypertension
Determine when the patient's needs exceed local resources or specialist expertise (requirement for transfer)

Attitudes

Demonstrates compassionate care of patients and relatives
Appreciates the importance of timely institution of organ-system support
Appreciates the differences between organ system support and specific treatment
Enquiring mind, undertakes critical analysis of published literature
Adopts a problem solving approach
Desire to minimise patient distress
Consults, communicates and collaborates effectively with patients, relatives and the health care team
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.