Intensive Care

Happy Twins
Draft proposed by Dr NC Fong
Reviewed by Dr Sabrina Tsao

Essential Skills

Domain 1 Professional Values & Behaviour

Domain 2 Communication

  1. Communication skill with parents and relatives of critically ill patients

Domain 3 Procedural Skills

  1. Intubation and CPR

  2. Intra-osseous infusion

  3. Set up of arterial lines for monitoring

  4. Thoracocentesis and chest drain insertion

  5. Use ultrasound to rule out pericardial effusion or pleural effusion, to assist vascular access, and to use bladder scan.

Domain 4 Patient Management

Additional desirable skills are listed in each proposal. These recommended skills are to be acquired as opportunity arises

Basic Training

Resuscitation

Basic concepts in paediatric cardiopulmonary resuscitation

Basic principle of mechanical ventilation

 Knowledge of ventilator setting, short- and long-term complications of ventilation, appropriate use of oxygen, interpretation of blood gas

Basic pharmacology and drug interaction

Use of inotropes, analgesic, sedative, neuromuscular blocking agents, anticonvulsants

Toxicology & poisoning

 

Shock

Knowledge of different types of shock and its basic management

 

Acute management of congestive heart failure and common arrhythmia

Common causes

Common manifestations

Use of common cardiac drugs.

Respiratory intensive care

Recognition of respiratory failure

Medications for status asthmaticus

Use of invasive and noninvasive respiratory support

Emergency treatment of pleural effusion and pneumothorax

Upper airway obstruction: croup, anaphylaxis

Neurological intensive care

Management of severe meningitis

Presentation of brain tumors and intracranial bleeding

Knowledge of raised ICP

Status epilepticus and treatment

Comatose patients

GBS, Transverse myelitis

Endocrine intensive care

DKA, hypoglycemia, CAH

Thyrotoxic storm, Cerebral DI, IEM emergency

Renal intensive care and electrolytes abnormality

Recognition of types of renal failure

Basic management of acute renal failure

Management of Hypo/Hyper Na, K, Ca, acid-base balance 

Haematology and oncology intensive care

Severe anaemia and bleeding tendency

Various emergency presentation of malignancy

Tumor lysis syndrome, Neutropenic fever

Use of blood products

Infection in intensive care

Rational use of antibiotics

Prevention of hospital acquired infection

Infection control routines

Gastrointestinal intensive care

Severe GI bleeding

Pancreatitis

Liver failure

Nutritional support

Enteral and parenteral nutrition in critically ill patients

Trauma

Management of multiple injuries

Management of head injury

Post-operative care

General surgery

Neurosurgery

Cardiac surgery (optional)

Psychological support and Bereavement

Psychological response of patients and their relatives towards PICU admission, morbidity and mortality

Counselling

 

Desirable Skill

Basic ventilator setting

Higher Training

Cardiology Intensive Care

Cardiogenic shock, malignant hypertension, arrhythmia, basic echocardiography, ECMO (optional)

Respiratory Intesive Care

Basic bronchoscopy, ARDS, advanced ventilation, ECMO (optional)

Renal Intensive Care

Knowledge of CRRT

Transport of PICU patients

Stabilization of sick children during interhospital transport

Palliative care in PICU

Ethical and legal issues related to withdrawal of  

Support and organ donation

Understand the principle of diagnosing brain death

Medical audit

Use of standards and protocols in PICU

Quality assurance programmes

 

Desirable skills

1. Vascular access for central venous pressure

2. Basic echocardiography & POCT Ultrasound

3. Basic bronchoscopy

4. CRRT and plasmapheresis

5. Understanding the different modes of ventilation